Evolution of stapedectomy prostheses over time.

The history of stapedectomy prostheses started in 1956, when John J. Shea first described the microsurgical technique of the stapedectomy procedure in which an otosclerotic stapes was replaced with a prosthesis made of Teflon. Over the years, the evolution of the prostheses was influenced by the changes in the microsurgical technique, materials used and technical properties. The materials evolved from Teflon, metal, to plastic, and most recently to gold and titanium. While initially the diameter of the pistons used was 0.8 and 0.6 mm, from the 1970s onwards, it has been becoming even smaller in order to ease the procedure and reduce the risk of inner ear damage. Improvement was made in the way the prosthesis is fixed to the long incus process, resulting in different solutions like Teflon memory effect, platinum and gold band, titanium-gold clip prostheses or nickel-titanium alloy. Eventually, the most decisive factor for successful surgery is surgical experience with a specific type of prostheses and the expertise in the microsurgery technique.