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Impact of manual crimping on stapedotomy outcomes

Published online by Cambridge University Press:  20 October 2022

F Couvreur Open the ORCID record for F Couvreur [Opens in a new window] ,
C Schlegel-Wagner  and
T Linder
F Couvreur*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Hospital, Bruges, Belgium
C Schlegel-Wagner
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
T Linder
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
*
Corresponding author: Floor Couvreur; Email: floorcouvreur@gmail.com
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Abstract

Background

The impact of tight stapes crimping on hearing is a matter of debate. Several studies postulate that tight crimping is essential for lifelong success, whereas others have debated whether firm attachment leads to incus necrosis. Several types of prostheses with different coupling mechanisms have been developed, and manual crimping remains the most frequently used technique. This study investigates whether tightness really does affect hearing outcome.

Methods

The hearing results of patients who underwent primary stapedotomies using three different titanium pistons were analysed. The surgeons categorised the firmness of the piston attachment into ‘tight’ and ‘loose’ crimping groups. Hearing outcome and reasons for revision surgical procedures were investigated.

Results

The mean post-operative air–bone gap for frequencies of 0.5–4 kHz was 8.80 dB for the tight crimping group (n = 308) and 9.55 dB for the loose crimping group (n = 39). No significant difference was found (p = 0.4650). Findings at revision procedures were comparable (1.6 per cent vs 5 per cent).

Conclusion

Although firm crimping is strongly advised, a movable loop upon palpation does not lead to unsatisfactory hearing results, and does not mandate piston replacement or bone cement use.

Keywords

Otosclerosisstapes surgery
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 9 , September 2023 , pp. 1027 - 1033
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr F Couvreur takes responsibility for the integrity of the content of the paper

References

Crompton, M, Cadge, BA, Ziff, JL, Mowat, AJ, Nash, R, Lavy, JA et al. The epidemiology of otosclerosis in a British cohort. Otol Neurotol 2019;40(suppl 1):22–30CrossRefGoogle Scholar
McGee, TM. The loose wire syndrome. Laryngoscope 1981;91(suppl 9):1478–83CrossRefGoogle ScholarPubMed
Shea, JJ Jr. Fenestration of the oval window. Ann Otol Rhinol Laryngol 1958;67:932–51CrossRefGoogle ScholarPubMed
Shea, JJ Jr. Thirty years of stapes surgery. J Laryngol Otol 1988;102:14–19CrossRefGoogle ScholarPubMed
Wegner, I, Kamalski, DMA, Tange, RA, Vincent, R, Stegeman, I, van der Heijden, GJ et al. Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review. Laryngoscope 2014;124:1687–93CrossRefGoogle ScholarPubMed
Huber, AM, Ma, F, Felix, H, Linder, T. Stapes prosthesis attachment: the effect of crimping on sound transfer in otosclerosis surgery. Laryngoscope 2003;113:853–8CrossRefGoogle ScholarPubMed
Ramsay, H, Karkainen, J, Palva, T. Success in surgery for otosclerosis: hearing improvement and other indicators. Am J Otolaryngol 1997;18:23–8CrossRefGoogle Scholar
Fisch, U, Oezbilen, G, Huber, AM. Malleo-stapedotomy in revision surgery for otosclerosis. Otol Neurotol 2001;22(suppl 6):776–85CrossRefGoogle Scholar
Kwok, P, Fisch, U, Strutz, J, May, J. Stapes surgery: how precisely do different prostheses attach to the long process of the incus with different instruments and different surgeons? Otol Neurotol 2002;23:289–95CrossRefGoogle Scholar
Wegner, I, Swartz, JE, Bance, ML, Grolman, W. A systematic review of the effect of different crimping techniques in stapes surgery for otosclerosis. Laryngoscope 2016;126:1207–17CrossRefGoogle ScholarPubMed
Rajan, GP, Atlas, MD, Subramaniam, K, Eikelboom, RH. Eliminating the limitations of manual crimping in stapes sugery? A preliminary trial with the shape memory nitinol stapes piston. Laryngoscope 2005;115:366–9CrossRefGoogle Scholar
Toth, M, Moser, G, Rosch, S, Grabmair, G, Rasp, G. Anatomic parameters of the long process of incus for stapes surgery. Otol Neurotol 2013;34:1564–70CrossRefGoogle Scholar
Skinner, M, Honrado, C, Prasad, M, Kent, HN, Selesnick, SH. The incudostapedial joint angle: implications for stapes surgery prosthesis selection and crimping. Laryngoscope 2013;113:647–53CrossRefGoogle Scholar
Fisch, U. Tympanoplasty, Mastoidectomy and Stapes Surgery. New York: Thieme, 2008CrossRefGoogle Scholar
Bittermann, AJN. Primary stapes surgery in patients with otosclerosis: prediction of postoperative outcome. Arch Otolaryngol Neck Surg 2011;137:780–4CrossRefGoogle ScholarPubMed
Vincent, R, Sperling, NM, Oates, J, Jindal, M. Surgical findings and long-term hearing results in 3,050 stapedotomies for primary otosclerosis: a prospective study with the otology-neurotology database. Otol Neurotol 2006;27:S25–47CrossRefGoogle ScholarPubMed
Fontana, M, Ferri, E, Lora, L, Babighian, G. A scanning electron microscopic study of crimping of stapedial prostheses. Auris Nasus Larynx 2012;39:461–8CrossRefGoogle ScholarPubMed
Farrior, J, Sutherland, A. Revision stapes surgery. Laryngoscope 1991;101:1155–61CrossRefGoogle ScholarPubMed
Tange, RA, Grolman, W. An analysis of the air-bone gap closure obtained by a crimping and a non-crimping titanium stapes prosthesis in otosclerosis. Auris Nasus Layrnx 2008;35:181–4CrossRefGoogle Scholar
Hüttenbrink, KB. Biomechanics of stapesplasty: a review. Otol Neurotol 2003;24:548–59CrossRefGoogle ScholarPubMed
Huber, AM, Veraguth, D, Schmid, S, Roth, T, Eiber, A. Tight stapes prosthesis fixation leads to better functional results in otosclerosis surgery. Otol Neurotol 2008;29:893–9CrossRefGoogle ScholarPubMed
Lesinski, SG. Causes of conductive hearing loss after stapedectomy or stapedotomy: a prospective study of 279 consecutive surgical revisions. Otol Neurotol 2002;23:281–8CrossRefGoogle ScholarPubMed
Wegner, I, Shahnaz, N, Grolman, W, Bance, ML. Wideband acoustic immittance measurements in assessing crimping status following stapedotomy: a temporal bone study. Int J Audiol 2017;56(suppl 1):1–7CrossRefGoogle ScholarPubMed
Marquet, J. Otosclerosis today. In: Filip, R. Otosclerosis. Amsterdam: Kugler and Ghedini, 1990;9–17Google Scholar
Anson, BJ, Winch, TR. Vascular channels in the auditory ossicles in man. Ann Otol Rhinol Laryngol 1974;83:142–58CrossRefGoogle ScholarPubMed
Schimanski, G. Erosion and necrosis of the long process of the incus after otosclerosis operation [in German]. HNO 1997;45:682–9CrossRefGoogle Scholar
Linder, TE, Volkan, G, Troxler, E. Objective measurements of ossicular chain mobility using a palpating instrument intraoperatively. Otol Neurotol 2015;36:1669–75CrossRefGoogle ScholarPubMed