Stapedial decapitation technique: as a management procedure for stapedial otosclerosis

Objective: The aim of this study is to compare between two surgical maneuvers in the management of stapedial type of otosclerosis, small fenestra stapedotomy and decapitation procedure as a new technique

Subjects and Methods: prospective study that included 21 consenting patients, 9 males and 12 females subjected to small fenestra stapedotomy operation and 22 consenting patients, 10 males and 12 females operated upon by decapitation technique

Results: Hearing sensitivity and air bone gap of the two groups before and after Operations were analyzed. The mean hearing threshold level [500-4000Hz] of preoperative versus post operative was compared. There was no significant statistical difference between the two techniques used in this study for both improvement of the hearing threshold and air bone gap closure after operations

Discussion: In this study, there were no significant statistical differences between the two groups in the management of the hearing loss due to stapedial type of otosclerosis. The improvement in air bone gap was not different between the two groups of the study. However, the decapitation technique was found to be easier. it has less manipulation around the stapedial footplate and this will minimize the incidence of floating footplate and postoperative vertigo, it also preserves the stapedial tendon and superstructure. It is to be noted that, the decapitation technique cannot be done with narrow oval window niche

Conclusion; The effectiveness and safety of both techniques are the same with the advantages of decapitation technique of providing the same hearing results, saving time and preserve the stapedial tendon in comparison with the small tenestra stapedotomy technique

Stapes surgery: preinsertion technique

Two hundred ears with otosclerosis have been operated upon using stapedotomy technique with insertion of the prosthesis before removal of the superstructure [preinsertion technique] in 100 ears and the usual stapedotomy technique as described by Schuknecht in 100 ears. The postoperative air-bone gap, calculated as the difference between the postoperative air and bone conduction levels, was smaller in the stapedotomy technique for all frequencies except at 2000 Hz, the differences were statically insignificant except at 4000 Hz, the mean postoperative air-bne gap was 8.7 dB and 7.5 dB for the 1st and 2nd group, respectively, which is statistically insignificant. We found no postoperative loss of bone conduction exceeding 15 dB in this series of patients. There was a deterioration of more than 10 dB in four ems, one in the first group and three in the second group. According to ow results we conclude that the small fenestra technique provides good results with minimal complications in treatment of otosclerosis. The preinsertion technique provides more advantages, being easier and minimize trauma to the inner ear

Stapes surgery: comparison between different prostheses

Four hundred and fifty ears with otosclerosis have been operated upon using 3 different types of prostheses [Teflon piston in 217 ears, Teflon platinum in 133 ears and House prostheses in 100 ears]. Greater hearing gains were obtained with the use of Teflon piston and Teflon platinum than House prostheses with statistically significant advantage at 2000-4000 Hz. The mean postoperative air-bone gap was not statistically significant with the use of the 3 prostheses but at 2000 and 4000 Hz the ABG was significantly larger with the use of House prostheses. According to our results, we conclude that Teflon piston and Teflon platinum provide better results than house prostheses and are considered the prostheses of choice for otosclerosis surgery