Date of Award

January 2019

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Elias Michaelides

Abstract

Objective: The aim of this work was to design and implement a sustainable database of stapes surgery and investigate impact of patient-specific and surgery-specific factors on hearing outcomes and complications after stapes surgery. Stapes surgery is occasionally complicated by an intraoperative tympanic membrane perforation (ITMP), raising concern for decreased hearing outcomes, postoperative infection, and sensorineural hearing loss (SNHL). We compared outcomes and complication rates in primary stapes surgeries with and without ITMP to assess the appropriateness of proceeding with surgery in the event of an ITMP.

Study design: Retrospective chart review and analysis of newly designed otosclerosis database.

Setting: Tertiary referral center.

Subjects and methods: All patient charts with a diagnosis of otosclerosis, seen between Feb 2008 and Sept 2017 at a tertiary referral center, were reviewed retrospectively. 706 primary stapes surgeries were analyzed, including 10 cases with an ITMP. Primary outcome measures were postoperative air-bone gap (ABG), air conduction (AC), and bone conduction (BC) pure tone average (PTA) thresholds. Postoperative complication rates, including infection, hearing distortion, and sensorineural hearing loss, were also compared.

Results: There was no significant difference between primary stapes surgeries with and without ITMP in postoperative ABG PTA (7.3 vs 5.77 dB, p = 0.75), postoperative AC PTA (37.5 vs 36.3 dB, p = 0.87), or postoperative BC PTA (29.1 vs 26.4 dB, p = 0.64). Primary stapes surgeries with ITMPs had no cases of postoperative surgical infection, hearing distortion, or SNHL.

Conclusions: To our knowledge, this is the first retrospective review of ITMP and hearing outcomes after stapes surgery. Using a newly designed otosclerosis database, our findings suggest that it is both safe and appropriate to proceed with primary stapes surgery in the presence of an ITMP with no increased risk of infection, SNHL, or worsened hearing outcomes.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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