Stapedotomy for tympanosclerotic stapes fixation: is it safe and efficient? A review of 68 cases.

OBJECTIVE

Performing stapedotomy in cases of tympanosclerotic stapes fixation is controversial. The procedure is traditionally considered to carry a high risk of postoperative sensorineural hearing loss. The aim of this study was to report the hearing results in surgically treated cases of stapes fixation.

STUDY DESIGN

A retrospective review of tympanosclerosis of the oval window with stapes fixation.

SETTING

The study was performed at the Jean Causse Ear Clinic in Clombiers, France.

PATIENTS

Sixty-five patients who underwent surgery for tympanosclerotic stapes fixation between January 1992 and October 1999.

INTERVENTION

Stapedotomy with vein graft interposition and reconstruction with a Teflon piston, or a total prosthesis in cases of incudal erosion.

MAIN OUTCOME MEASURES

Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone conduction threshold, air conduction threshold, and Glasgow Benefit Plot were measured.

RESULTS

Postoperative air-bone gap closure to within 10 dB was achieved in 39% of cases. An air-bone gap less than 20 dB was obtained in 70% of cases. Significant postoperative improvement of air conduction thresholds, more than 20 dB, was found in 46% of cases. The postoperative bone conduction thresholds were unchanged in 92% of cases. No significant sensorineural hearing loss was seen in this series.

CONCLUSION

This series demonstrates that safe and successful stapedotomy is possible if certain rules are respected.