The Long Prosthesis Syndrome *
Disequilibrium, lack of concentration and memory loss. (13:44)
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Dr. William H. Lippy has just written in the April Journal of Otology and Neurotology a “Letter to the Editor” documenting the cure for memory loss following stapedectomy surgery for otosclerosis. The paper entitled – “The Long Prosthesis Syndrome” focuses on two recent cases that were referred to Dr. Lippy, following stapedectomy surgery for otosclerosis. Both patients had suffered further hearing losses, severe disequilibrium, lack of concentration and extreme memory loss.

Click here for original Journal Article

Primary Stapedectomy Diagramatic Part 1

The technique of primary stapedectomy using a vein graft, and the self centering titanium Robinson Piston.  The emphasis is on Intraoperative testing and the value of local anesthesia.   (16:42)   Click here to view

Primary Stapedectomy Diagramatic Part 2 (4:47)
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Primary Stapedectomy Surgery
Actual stapedectomy with the emphasis on technique, use of the speculum holder, a control hole and placement of the prosthesis. The laser must be used when indicated. (7:23)    Click here to view

Stapedectomy Revision: Patient Selection *
Based on 2000 revision cases-do not revised in the 1st two months. Surgeon must be laser experienced. Best results obtained when after the previous surgery, the hearing went up and then down. Vibration means a short prosthesis. (10:36)
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Revision Stapedectomy *
A patient must have at least a 20 dB air bone gap and above 70% discrimination unless the less is severe. Do under local and use intraoperative testing. Check for malleus fixation. (16:11)   Click here to view

The Tuning Fork *
Details of how to use the tuning fork- If the tuning forks and the audiogram disagree, it is usually the tuning fork that is correct. The Weber is more sensitive than the Rinne. (12:13)    Click here to view

Juvenile Stapedectomy
Most of these are done where the disease is bilateral. Expect a much larger percentage of obliterative otosclerosis requiring drill out. The results are almost as good as in adults. (3:30) Click here to view 

Pregnancy and Otosclerosis
We were all taught that the hearing is otosclerotic woman became worse with Pregnancy. This information was positively incorrect. (6:40)    Click here to view

Revision of a Smart Prosthesis Surgery *
Made by Gyrus is easy to insert, but unfortunately has a memory and in relatively short periods of times it becomes nonfunctional in many cases. (4:00)  Click here to view

Stapedectomy for the Elderly *
The elderly did just as well with stapedectomy as did the younger population. There was no higher incidence of vestibular symptoms. (2:34)    Click here to view

Stapedectomy In Pilots
Pilots who are in control of the aircraft may have a stapedectomy if a tissue graft is used. It is important to put them through a decompression chamber 3 months after surgery. (6:43)   Click here to view

Stapedectomy in the 60’s through 90’s
In the early days of stapedectomies there were many more cases of obliterative otosclerosis than we see now because now the patient has surgery earlier in the course of the disease. (4:51)   Click here to view 

Far Advanced Otosclerosis *
These are patients with no air measurements and no bone conduction preoperatively. Successful results were based on being able to use a hearing aid again, increase in discrimination and an increase in the hearing. (4:16)
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Facial Nerve *
As long as there is any access at all to the footplate, even by pushing the facial nerve aside, it is appropriate to do a stapedectomy. (3:47)   Click here to view

Revision of Eroded Incus 
As long as there is even a small amount of the incus remaining a case can be revised using a modified Lippy prothesis. If the incus comes to a point it should be squared using a laser. (10:28) Click here to view

Stapedectomy vs. Stapedotomy *
We do not believe that stapedotomy is a superior procedure. The otologist should know how to do both procedures, utilizing a tissue graft if a stapedectomy is necessary.(5:01)   Click here to view

Promontory Drilling
This is absolute acceptable and non-harmful. It may be used when there is a promontory overhang or the incus is too long. Sweep up from the footplate and do the drilling in the posterior portion of the oval window area.
(3:09)   Click here to view 

Intraoperative Audiometry
This is imperative in our practice in revision stapedectomy. It is also wonderfully useful in primary stapedectomy in tympano-ossiculoplasty. (9:35)    Click here to view

Floating Footplate
In primary stapedectomy when the footplate inadvertently mobilizes and you do not have a hole in it, cover the footplate with a tissue graft and place the prosthesis. These cases are among our very best results. (4:30)   Click here to view  

B.A.H.A. (9:50) *
Discussion of indications for BAHA implant. Patients with single sided deafness, mixed conductive nerve hearing loss and atresia are all candidates. Pre-operative evaluation is done with a test band to show the patients how they will hear with the implant.  Click here to view

Steps of the B.A.H.A. Surgery (3:37)
Technical discussion of BAHA implant with emphasis on proper surgical handling. Principles of skin graft, wound handling and tensionless closure are emphasized to minimize post-operative problems.
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High Body Mass Index and skin overgrowth with the B.A.H.A. (7:32) A discussion of risk factors for skin overgrowth in BAHA surgery. In almost 100 patients the group that was more predisposed to scarring problems were the obese males. An elongated implant usually helps in these patients. Click here to view

Total Ossiculoplasty (8:48) One of the more difficult middle ear reconstructions is total ossiculoplasty. This is due to not having a healthy middle ear bone to stabilize a prosthesis on, as in stapedectomy or partial ossiculplasty. In addition these patients usually have more chronic ear disease and many have had mastoidectomy performed. Two point stabilization assists in improving results in these difficult reconstructions.  Click here to view