Objective: To demonstrate non-inferiority of endoscopic stapedotomy to microscopic stapedotomy for the treatment of otosclerosis. Study Design: Single-blinded randomized control trial. Setting: Tertiary, academic otology-neurotology practice. Patients: Adult subjects with a diagnosis of otosclerosis and a preoperative air-bone gap (ABG) more than or equal to 20 dB undergoing primary stapedotomy. Intervention: Endoscopic or microscopic stapedotomy. Main Outcome Measures: Primary audiometric outcome was postoperative ABG. Secondary audiometric outcomes included speech reception threshold (SRT), word recognition score (WRS), bone-and air-conduction pure tone averages (PTA), change in ABG, and ABG closure rates to less than or equal to 10 dB and less than or equal to 20 dB. Results: Twenty-two patients were recruited. Eleven patients underwent endoscopic stapedotomy and 11 underwent microscopic stapedotomy. The endoscopic group was non-inferior to the microscopic group in terms of postoperative audiometric outcomes (endoscope versus microscope, p-value): ABG (8.1 dB versus 8.1 dB, <0.001), SRT (27.7 dB versus 25.9 dB, <0.001), WRS (92% at 65 dB versus 98% at 62 dB, <0.001), air-conduction PTA (33.5 dB versus 30.8 dB, <0.01), and change in ABG (23.0 dB versus 20.7 dB, <0.0001). ABG closure rates to less than or equal to 10 dB (72.7% versus 81.2%, p ¼ 1.0) and less than or equal to 20 dB (90.9% versus 100%, p ¼ 1.0) were not significantly different. There was no significant difference in operative time, necessity of scutum curettage, or postoperative dysgeusia. No patients required chorda tympani sacrifice. Preoperative tinnitus resolved in three patients in each group postoperatively. Conclusions: This study is the first randomized control trial to demonstrate non-inferiority of endoscopic to microscopic stapedotomy.
Prof Ward published 109 articles in peer reviewed international medical journals, 91 included in the ISI database where they are quoted more than 800 times. She already was the editor of one book on thyroid diseases and helped editing three other books, wrote 40 books chapters and has participated with more than 200 presentations in both Brazilian and international congresses. In addition, teaching and supervising medical and research students represents an important aspect of her academic activities having supervised the accomplishment of 10 PhD`s and 21 Masters from UNICAMP. In the year 2011, Prof Ward was awarded the Latin American Thyroid Association prize. X PrefaceFinally, the third section, Treatment of Thyroid and Parathyroid Diseases, is designed mostly to the young practitioner. In fact, the field of thyroid and parathyroid surgery as well as thyroid diseases treatment modalities have undergone rapid change in the past few years with the advent of new techniques and the appearing of new basic and clinical evidences. Also, we need to understand how hormone analogs may affect our glands and a hole chapter is devoted to this subject.The burden of thyroid and parathyroid diseases continue to increase and a better knowledge of these pathologies molecular, epidemiological and clinical behavior is essential in order to better manage our patients.Thyroid and Parathyroid diseases aims to provide meaningful information to the practitioner through the eyes of though leaders in the discipline who have contributed their time and expertise to this effort. It is not a comprehensive textbook but rater a carefully chosen collection of very important topics written and illustrated in a form that hopefully will please all, the clinicians, the surgeons, the pathologists, the radiologists and all the fans of the head and neck diseases.Hope you enjoy it!
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