388 LETTERS TO THE EDITOR radiological findings concerning the ossicular chain are Department of Anatomy not universally well documented in the case reports and Normandie Univ. case series that discuss the treatment of a PSA. This is France probably due to the fact that the publication dates of these reports span quite a few decades (1963 – 2014), a time Marc Labrousse, M.D., Ph.D. during which the CT technology was invented (in 1972) Department of Otolaryngology–Head and Neck Surgery and has been dramatically improved. Because of this, we Hopital Robert Debre´, CHU de Reims were not able to review the usefulness of CT in deter- Reims France mining the cause of conductive hearing loss in a suffi- ciently large series of operated PSA patients. Department of Anatomy, University of Reims As Hitier et al. point out, another helpful tool in deciding Champagne-Ardenne on the surgical strategy is the peroperative evaluation by the surgeon of the ossicular chain mobility. The outcome France of this procedure has been reported in 13 of 18 reviewed cases, and a stapes footplate ankyloses is reported in 12 of Vincent Patron, M.D., M.Sc. 13 evaluated cases. It is however still unclear whether the Department of Otolaryngology–Head and Neck Surgery observed impaired stapes mobility in patients with a PSA CHU de Caen is invariably caused by radiologically evident fenestral Caen, France otospongiosis, or that other pathophysiological phenom- ena also play a role. Nevertheless, we think that the The authors disclose no conflicts of interest. surgeon should be aware of the association between the DOI: 10.1097/MAO.0000000000001722 occurrence of a stapedial artery and impaired stapes mobility that is not caused by the stapedial artery directly. REFERENCES Our empirical data suggest that in the majority of patients suffering from conductive hearing loss due to 1. Goderie TPM, Alkhateeb WHF, Smit CF, Hensen EF. Surgical a PSA, impaired stapes mobility plays an important role, management of a persistent stapedial artery: a review. Otol Neurotol 2017;38:788 – 91. and that in these cases a stapedotomy (with or without 2. Govaerts PJ, Marquet TF, Cremers C, Offeciers FE. Persistent transection of the PSA) is an effective treatment. In stapedial artery: does it prevent successful surgery? Ann Otol Rhinol patients suffering from pulsatile tinnitus caused by a Laryngol 1993;102:724 – 8. PSA, coagulation or transection is safe and should there- 3. Hitier M, Zhang M, Labrousse M, Barbier C, Patron V, Moreau S. fore be considered. Persistent stapedial arteries in human: from phylogeny to surgical consequences. Surg Radiol Anat 2013;35:883 – 91. These insights may help the surgeon in selecting the 4. Hogg ID, Stephens CB, Arnold GE. Theoretical anomalies of the optimal surgical strategy in patients suffering from a stapedial artery. Ann Otol Rhinol Laryngol 1972;81:860 – 70. symptomatic PSA: transecting the PSA, a stapedotomy, or both. Erik Frans Hensen, M.D., Ph.D. RESPONSE TO ‘‘BREAKING THE MYTH OF Department of Otolaryngology/Head and Neck Surgery CENTRAL NEUROLOGICAL COMPLICATIONS Section Ear and Hearing, VU University Medical Center IN STAPEDIAL ARTERY SURGERY’’ Amsterdam, Amsterdam The Netherlands In Reply: We read with great interest the comment of Hitier et al. on the article ‘‘Surgical management of Department of Otolaryngology/Head and Neck Surgery a persistent stapedial artery’’ by Goderie et al. The detailed description of the embryological development Leiden University Medical Center of the stapedial artery by Hitier et al. and the empirical Leiden, The Netherlands evidence put forward by Goderie et al. both reinforce the view that persistent stapedial artery (PSA) transection or Thade´ Pieter Marie Goderie, M.D. coagulation is a safe procedure with respect to central Conrad Frits Smit, M.D., Ph.D. neurological sequelae. Department of Otolaryngology/Head and Neck Surgery Furthermore, we fully concur with the author that in Section Ear and Hearing, VU University Medical Center determining the treatment strategy for a symptomatic Amsterdam, The Netherlands PSA, all treatment options should be considered and firstname.lastname@example.org discussed with the patient, including hearing aids and the different surgical options as discussed in the review by Goderie et al. All authors have disclosed no financial interests, Nowadays, preoperative high-resolution computed arrangements, or affiliations in the context of this activity. tomographic (CT) scans are very helpful in predicting The authors disclose no conflicts of interest. the presence of otospongiosis; however, its use or the DOI: 10.1097/MAO.0000000000001723 Otology & Neurotology, Vol. 39, No. 3, 2018 Copyright © 2018 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
Otology & Neurotology – Wolters Kluwer Health
Published: Mar 1, 2018
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