Article
Investigations on the "lateralization" of pistons after stapes surgery
Search Medline for
Authors
Published: | August 3, 2011 |
---|
Outline
Text
Introduction: There are a few cases of necessary revision stapes surgery, despite an overall high success rate. It is important to differentiate between primary and secondary failure. To explore the reasons for failure in depth, a second exploration of the middle ear is frequently performed. As well as the arrosion of the processus lenticularis, the "lateralization" of the piston is also mentioned in the literature. The purpose of this research is to explore these causes based on our patient population.
Methods: We analysed data concerning revision stapes surgery in our hospital retrospectively from 1991 until 2010. In order to further investigate the cause of “lateralization” we evaluated the location of the prosthesis and its relation to the stapes base intraoperatively. Additionally, light and electron microscopes have been used to examine tissue samples.
Results: 44 operative revisions have been performed. Within those cases, arrosion of the processus lenticularis was present to a variable extent. In addition to the known "lateralization", a distortion of the prosthesis axis was observed. The microscopic samples of the incus showed no signs of any inflammatory or ischemic processes. As described in the literature, a proliferation of connective tissue was observed.
Discussion: Based upon the current literature and our investigations, we believe that the pathomechanism of the "laterized piston syndrome" is due to the traction forces of connective tissue – the stapes is pulled away from the oval window. There is further evidence that a variable growth of connective fibers is found in different types of prosthesis.