0.4 mm stapedotomy: a consistent technique for otosclerosis.

With the decline in the number of patients requiring stapes surgery for otosclerosis, there has been increasing concern over the ability of Otololaryngologists to perform these procedures. An approach must be easily learned, consistent and applicable to all operative situations. The technique of stapedotomy utilizing a 0.4-mm diameter fenestra, with placement of the prosthesis prior to removal of the stapes superstructure offers a consistent approach with low potential for morbidity. Fifty-six consecutive procedures of stapedotomy utilizing this approach were performed. Eighty-seven percent of cases had closure of the air-bone gap to within 10 dB, with 96 percent of the patients closing with 20 dB. There were no cases of perilymphatic fistula, sensorineural hearing loss or other otologic complications. This technique has proven reliable, while minimizing vestibular trauma.