Forty years of stapes surgery.

OBJECTIVE

This study reports the results of 14,449 stapedectomy operations performed during the past 40 years.

STUDY DESIGN

The study design was a retrospective case review. Approximately 100 operations were selected from each of the past 40 years, for a total of 5,444 operations, from which the results with the whole group were extrapolated.

SETTING

All operations were performed in a hospital during the first 30 years and in an ambulatory surgery center in the past 10 years.

PATIENTS

All patients in the study were the private patients of the author and were operated on by him personally. These patients had otosclerosis only.

INTERVENTIONS

Stapedectomy was performed on all patients.

MAIN OUTCOME MEASURES

The change in hearing after the operation was reported. Using the hearing of the average for 500, 1,000, and 2,000 Hz, the criteria for success were defined as closure of the air-bone gap to 10 dB or less and no decline in speech discrimination of >10%.

RESULTS

In the primary stapedectomy group, success was achieved in 95.1% of ears after 1 year, 94.7% of ears after 2-5 years, and 62.5% after >30 years. In the revision stapedectomy group, success was achieved in 71.1% after 1 year, 62.4% after 2-5 years, and 59.4% after 6-36 years.

CONCLUSIONS

The immediate success rate after primary and revision stapedectomy declines slowly over time, because of delayed conductive hearing loss and further sensorineural hearing loss, more than one would expect in matched control subjects without otosclerosis. Stapedectomy has stood the test of time as the first successful microsurgical operation.