How I do primary and revision stapedectomy.

Localized anterior otosclerosis is found in about 80 percent of primary stapedectomy operations. For these patients, partial stapedectomy with vein graft is recommended. Obliterative otosclerosis is the pathology found in the remaining 20 percent of primary stapedectomy operations. In these cases, stapedectomy with lining membrane of the middle ear or vein graft is the procedure of choice. Revision stapedectomy may improve conductive hearing loss caused by (1) migration and/or dislocation of the prosthesis, (2) eversion of the lining membrane of the vestibule with resulting dislocation of the prosthesis and possible erosion of the lower incus, (3) bony closure of the oval window, or (4) epitympanic fixation of the incus and/or malleus. Successful operative techniques used in primary and revision stapedectomy are described.