Stapedotomy with stapedius tendon preservation: technique and long-term results.

From 1975 to 1992, a total of 1459 primary stapedoplasty operations (i.e., stapedectomy, stapedotomy with tendon section, and stapedotomy with tendon preservation) were performed in 1323 subjects at the Ear, Nose, and Throat Department of the University of Verona. Pure-tone audiometry was carried out in all subjects who were operated on and who underwent 6-month and 10-year follow-ups. To evaluate the influence of stapedius tendon preservation on functional outcome, we randomly selected subgroups of patients using the three different stapedioplasty techniques and tested them by multiple-frequency tympanometry, psychoacoustic tuning curves, and speech discrimination in noise. Finally, to assess the effect of prosthesis diameter on middle ear transfer function, we used the electrocochleographic technique and examined the threshold and latency of cochlear nerve compound action potentials recorded during surgery from the round window. The results of this study show that the best auditory performance in otosclerotic subjects is achieved by performing a stapedotomy of 0.7 mm diameter, using a 0.6 wire-Teflon piston, and preserving the stapedius tendon.