Small fenestra stapedotomy for otosclerosis in a Canadian teaching centre.

OBJECTIVE

This study reports the results of 112 primary stapedotomies and 13 revision stapedotomies performed by the senior author.

STUDY DESIGN

Retrospective case review of all primary and revision stapedotomies performed at University Hospital between 1994 and 1999. All patients in this series had otosclerosis and underwent stapedotomy using a 0.6-mm diameter platinum wire/Teflon piston prosthesis. The air-bone gap was calculated as the difference between the preoperative boneconduction and the postoperative air-conduction thresholds. The average follow-up time post-stapedotomy to audiometric testing was approximately 2.5 months.

OUTCOME MEASURES

An average air-bone gap closure at 500, 1000, and 2000 Hz to 10 dB or less was used as the criterion for success. The effects of stapedotomy on speech reception thresholds (SRTs), speech discrimination scores (SDSs), and airconduction thresholds are also reported.

RESULTS

In primary stapedotomy, an air-bone gap closure of 10 dB or less was achieved in 85.7% of patients. A significant hearing gain was achieved at all frequencies (250-8000 Hz), with the greatest benefit being achieved at the lower frequencies. The SRT was significantly improved post-stapedotomy by an average of 26.7 dB, and no significant change was found in the SDS. In revision stapedotomy, 38.5% of patients had a significant hearing gain at 250 to 4000 Hz. The SRT was significantly improved postoperatively by an average of 12.7 dB, and no significant change was found in SDS. Overall complication rates were similar to other series with two cases of partial hearing loss (1.6%), one incus fracture (0.8%), one large tympanic membrane perforation (0.8%), and one perilymphatic fistula (0.8%), which was successfully repaired. No patients in this series experienced complete sensorineural hearing loss, facial nerve injury, worsened tinnitus, or reparative granuloma.

CONCLUSIONS

The results of this study are comparable to other similar studies examining the use of stapedotomy in patients with otosclerosis. The high success rate and low incidence of serious complications support stapedotomy, without a laser but with resident involvement, as a highly effective treatment for otosclerosis.