Stapes surgery in residency - the ufpr clinical hospital experience

Abstract

Postoperative hearing gains considered as surgical success were inferior to published results in the literature, done by experienced surgeons.

Stapedotomy in a residency training program

“…In this study, 68.4% of the patients achieved a postoperative gap less than or equal to 10 dB. This result is in agreement with other studies conducted in training centers in which the surgical success ranged from 48% to 87% [6][7][8][9][10][11] . An accurate comparison between studies is difficult and was not our goal.…”

“…Other studies in training institutions present this high discrepancy. Vernick 6 reported 13%, Freitas et al 7 obtained 15.8%, and Caldart et al 9 found a difference of 24.56%. This disparity in closure could be inconsequential to technical problems related to the level of experience of the surgeon.…”

“…The residents were consistently under the supervision of an otological surgeon. The following steps outline the surgical technique: (1) local or general anesthesia, (2) infiltration of the external auditory canal with lidocaine with epinephrine (1:100,000), (3) incisions at 6 and 12 hours, 1 cm from the tympanic annulus, and uniting them later, (4) raising of the annulus and tympanic membrane with preservation of the chorda tympani nerve if possible, (5) palpation of the ossicular chain to evaluate the mobility, (5) curettage of the posterior-superior bony ridge for perfect visualization of the stapes footplate on the oval window, incus-stapes joint, tympanic branch of the facial nerve, pyramidal process and stapedial ligament, (6) measurement of the height of the prosthesis from the stapes footplate and the incus long process; (7) manual fenestration of the stapes footplate, (8) disarticulation of the joint connecting the incus to the stapes; (9) fracture and removal of the stapes superstructure; (10) positioning of the prosthesis, (11) placement of the fat originating from the earlobe around the fenestra and the prosthesis, (12) repositioning the tympanic-meatal flap; (13) placement of Gelfoam ® in the ear canal; and (13) operative wound care 4,5 .…”

“…Expert surgeons obtain the best results and achieve a success rate above 90%, with less than 1% sensorineural hearing loss (SNHL) 3 . The success rates as high as these are not reached in most training centers [6][7][8][9][10][11] . Because stapedotomy is elective surgery, in which the major objective is hearing improvement, some authors question the training in stapes surgery during medical residency 6,11,12 .…”

Applied Force during Piston Prosthesis Placement in a 3D‐Printed Model: Freehand vs Robot‐Assisted Techniques

“…1,2 Furthermore, despite the high overall rate of positive outcomes, there remains a risk for complications, including total irreversible sensorineural hearing loss. 3,4 As such, stapes surgery is one of the most litigated procedures within neurotology, with successful claims resulting in the second-highest mean payment per claim within the subspecialty at $2,733,000. 5 Complicating matters further is the decreasing volume of these procedures and the limited availability of high-fidelity, low-cost models to adequately facilitate resident/fellow training.…”