Stapedectomy versus stapedotomy: a comparison.

Two hundred and fifty consecutively operated stapes procedures operated by the author for otosclerosis are presented. A fat-wire stapedectomy prostheses (Schuknecht) was used in 152 cases and a Fisch teflon-wire piston was used in 98 ears. Of the 250 procedures 33 patients had bilateral surgery. The operations were done in local anaesthesia in most cases and with endomeatal incision. The fat-wire prostheses gave in 95% a closure within 10 dB and the rest 5% closed within 11-20 dB. The Fisch teflon-wire piston gave a closure within 10 dB in 87%, within 11-20 dB in 12% and within 21-30 dB in 1%. The speech reception was better after operation in 97% of patients operated with the fat-wire prostheses and in 99% of patients having the teflon-wire piston. It was a significant difference at 20 dB level of speech improvement (p < 02) in favour of the teflon-wire piston. The surgery for otosclerosis is a special procedure seeking refinements in surgical techniques to increase safety and maintain acceptable results. Our results show that the small fenestra technique with 4 mm piston will give better speech reception and better hearing in the high frequencies. To achieve a high standard the operations for otosclerosis should probably be centralised to let the surgeon do a minimum of 8 to 10 procedures every year.