The influence of the footplate-perilymph interface on postoperative bone conduction.

In a prospective study, 165 total stapedectomies and 152 small fenestra stapedotomies were performed by three experienced surgeons between 2001 and 2003. In total stapedectomy, a self-made Schuknecht steel wire connective tissue prosthesis, and in stapedotomy, a 0.6-mm platinum wire Teflon piston was used. The pre- and postoperative bone conduction thresholds were compared at the frequencies 250 Hz, 500 Hz, 1 kHz, 1.5 kHz, 2 kHz, 3 kHz and 4 kHz. The postoperative bone conduction between 250 Hz and 3 kHz was significantly better in the total stapedectomy group than in the stapedotomy group. At 4 kHz, both groups showed a slight decrease in bone conduction but the difference was not statistically significant. Therefore, especially in cases with preoperative moderate sensorineural hearing loss, we recommend total stapedectomy using a Schuknecht steel wire connective tissue prosthesis, which offers a stapes-perilymph interface similar to the normal stapes.

Microtraumatic stapedotomy.

Several modifications have been introduced during the 35 years following the first stapedectomy. The size of the footplate fenestration into the vestibule defines the type of the surgical technique, varying from total stapedectomy to partial stapedectomy or small fenestra stapedotomy. This paper presents a new microtraumatic modification of stapedotomy. After the incudostapedial joint is separated and following the fracture of the stapes crura, the stapes superstructure with the stapes tendon intact is left lying or bending on the promontory. Then, a 4.5-mm-long Schuknecht prosthesis is inserted and the oval window is sealed with small pieces of connective tissue filling the oval window niche and the area between the stapes crura. The results of the new microtraumatic technique with regard to hearing were similar to the standard small fenestra stapedotomy (closure of the air-bone gap). However, multifrequency tympanometry revealed that the new technique provides the patient with a complete physiological middle ear function postoperatively, which was not the case when the other stapedotomy techniques were used. This was reflected in a better hearing quality and less loud-noise intolerance reported by the patients who had been operated on with the new microtraumatic technique.