Stapedotomy technique and results: Ten years' experience and comparative study with stapedectomy

Abstract

Fifty of the 810 patients who underwent stapedotomy for otosclerosis from 1969 through 1988 were randomly chosen for follow‐up of at least 5 years. Most of the patients (65%) had follow‐ups of 10 years after stapedotomy, but another 50 patients who underwent stapedectomy had follow‐ups of longer than 10 years. In 50 patients, stapedectomy under local anesthesia was performed by removal of the footplate of the stapes, using an endaural incision, and covering the oval window with Gel‐foam®. In the other 50 patients, stapedotomy was performed under general anesthesia, using an endopreauricular incision, making a small hole in the footplate, and covering the hole only with blood from the surgical area. Although both groups showed improvement in hearing after the operation, the air‐bone gap in the stapedotomy group was significantly better than that in the stapedectomy group. The use of the endopreauricular incision under general anesthesia was preferable to endaural incision under local anesthesia because the operative field was wider, more convenient for the surgeon, and conducive to patient safety. There were no significant complications in either group. Our experience suggests that stapedotomy is the procedure of choice for otosclerosis.

Long-Term Results of a New Stapedotomy Prosthesis

“…Up to now, after using this piston for 5 years, we have no patients with symptoms associated with perilymphatic fistula due to the lack of seal. Postoperative hearing results following implantation of the new piston are similar to those achieved with other commercially available pistons [6,10]. Air-bone gap closure within 10 dBHL was observed in 83.3% of cases in our series.…”

“…Ever since, great efforts have been made towards improving the biomedical properties of the implants as well as the surgical technique itself [2,3]. Although stapedectomy, involving the removal of stapes completely, was the initial surgical technique, it has largely been replaced today by the stapedotomy or small fenestra method [4][5][6]. The use of laser in stapes surgery has also been introduced as an attempt to improve surgical efficiency [7,8].…”

Differences in Postoperative Hearing Outcomes and Vertigo in Patients with Otosclerosis Treated with Laser-Assisted Stapedotomy versus Stapedectomy

“…In recent trends, stapedotomies have been advocated for better hearing improvement and a lower incidence of SNHL [3,4,6,8,10,12,13,14,15]. In contrast, reports supporting stapedectomies have shown a larger overclosure in the PTA at 0.5, 1, and 2 kHz [16], a larger overclosure in the ABG at low frequencies [9], larger hearing gains at all frequencies [17], and equal postoperative SNHL [4,9,10].…”

Laserstapedotomie

“…Die Studien kommen zu unterschiedlichen Ergebnissen in Bezug auf die Verbesserung der Schallleitung. In der einen Studie wird kein signifikanter Unterschied beschrieben [16], während in der anderen eine signifikant bessere Schallleitung nach Stapedotomie nachgewiesen wurde [31]. Eine dritte Studie, bei der die partielle Stapedektomie, die totale Stapedektomie und die Stapedotomie vergleichen werden, kommt zu dem Ergebnis, dass im frühen Follow-up die Stapedektomie bessere Hörergebnisse ergab, jedoch über die Zeit die Stapedotomien bessere Ergebnisse lieferten [40].…”

“…Eine dritte Studie, bei der die partielle Stapedektomie, die totale Stapedektomie und die Stapedotomie vergleichen werden, kommt zu dem Ergebnis, dass im frühen Follow-up die Stapedektomie bessere Hörergebnisse ergab, jedoch über die Zeit die Stapedotomien bessere Ergebnisse lieferten [40]. Bei konventionellen Eingriffen wird beim Vergleich der Literatur eine mittlere residuelle Schallleitung von ≤ 10 dB in zwischen 40 und 96% der Fälle erreicht und von ≤ 20 dB in zwischen 68 und 99% der Fälle [14,31,40,43,44,49]. Ein direkter Vergleich postoperativer Ergebnisse der CO 2 -Laser-Stapedotomie und der konventionellen Stapedektomie ist in der Literatur nicht verfügbar.…”