Recent and future trends in the management of otosclerotic conductive hearing loss.

The protection of cochlear function following stapedectomy has emerged as the major problem in the surgical treatment of otosclerosis. Both immediate and delayed sensorineural losses continue to occur in spite of refinements of technique. The frequency and extent of these complications has been investigated by prospective and retrospective studies of the author's patients. It has been concluded that the size of the footplate fenestration plays a major role in the outcome, both immediately, and in the long term. Revision operations are necessary when initially good results rapidly deteriorate, both to resolve complications such as perilymphatic fistulae and also to restore function. Although second ear operations are usually worthwhile, they should be performed only when certain specific criteria have been met. The expected duration of unaided hearing gain, although often adequate when a standard large fenestra operation is performed, is considerably prolonged by restricting the size of the footplate to less than half its total area. For reasons unknown, bone conduction thresholds appear to be better, eventually, in operated as compared to unoperated ears.