Preservation of the stapedial tendon in surgery for otosclerosis

Abstract

The stapedius tendon is routinely transected during stapes surgery. The objective of this study was to evaluate the technique of stapedial tendon preservation during stapes surgery and to compare results of these cases with cases where the stapedial tendon was not preserved. Two groups of patients were evaluated. In group A (34 patients), the stapedial tendon was preserved as follows: the stapedial suprastructure with the preserved muscle tendon was transpositioned onto the longer arm of the incus and secured with a wire loop. Stapedial muscle function was evaluated by monitoring stapedial reflex (SR) 1 and 3 months after surgery. The mean uncomfortable level (UCL) was also measured after surgery and the results of group A were compared with those obtained in group B (33 patients), who underwent standard surgery with stapedial muscle tendon severance. One month after surgery, in group A patients SR was evoked in 21 patients (61.1%) and 2 months later in 32 patients (94.1%). One month after operation, in group A patients UCL was 108.8 dB, while 3 months after surgery it increased to 114.1 dB. In group B patients, the relevant values were 97.8 dB 1 month after surgery and 98.0 dB 3 months after operation (p<0.0001). Based on the results, it is recommended that the stapedius tendon must be preserved whenever possible, and it has been proved by the fact that the patients with the preserved muscle tendon had a higher noise discomfort threshold level.