Lateral Semicircular Canal Fenestration for Congenital Conductive Hearing Loss: Solution for a Dilemma

Abstract

In the October issue of Otolaryngology-Head and Neck Surgery, Ashtiani et al 1 published an interesting article on their experience with the classic fenestration of the lateral semicircular canal (LSCC) in cases of congenital conductive hearing loss. The classic fenestration procedure was invented in 1922 by Holmgren (Sweden), introduced in the United States by Sourdille (France) in 1937, and popularized by Lempert (United States) in 1938. In 1948, Holmgren 2 stated, "The improvement in hearing is far from always permanent. In a large number of cases it regresses after a short or long period, and then usually returns to the pre-operative condition." According to Jones, 3 the greatest failure was a bony regrowth that closes the artificial window. No method has been devised that ensures against closure. Any surgeon reporting according to accepted standards who attains a 60% hearing improvement by his surgery may assure himself that he is getting excellent results. 3 The closure of the fenestration fistula was the important issue in the high times of the fenestration era. Lempert invented the Nov-ovalis approach with later the cartilage "stopple" 4 to attack with moderate success the problem of reclosure of the LSCC fenestration.The application of the fenestration of the LSCC for congenital conductive hearing loss is far from new as a solution for the mentioned dilemma. Ombredanne from Paris 5 described in 1947 the fenestration of LSSC for congenital conductive hearing loss, and later in the 1960s, he reported more than 600 cases. In the 1950s, reports appear also on the experience with the fenestration in congenital conducting hearing loss. Unfortunately, the authors were unable to present this information in the recent article.Essential for the Lempert fenestration is the removal of the incus and the malleus head. It is not clear from the present article if this procedure has been followed. The color pictures do not solve this dilemma. It is surprising in this article that in the follow-up, there is no case of chronic otorrhea or at last closure of the fenestration after the surgery. The hearing results are extraordinarily positive when we compare the results with the data described by the masters of the fenestration of LSSC after 25 years of experience with this type of ear surgery in congenital conductive hearing loss. It might be possible that not performing a partial ossiculectomy is the reason for the good results in this study.