Stapedotomy for tympanosclerotic stapes fixation: is it safe and efficient? A review of 68 cases.

Abstract

Performing stapedotomy in cases of tympanosclerotic stapes fixation is controversial. The procedure is traditionally considered to carry a high risk of postoperative sensorineural hearing loss. The aim of this study was to report the hearing results in surgically treated cases of stapes fixation. A retrospective review of tympanosclerosis of the oval window with stapes fixation. The study was performed at the Jean Causse Ear Clinic in Clombiers, France. Sixty-five patients who underwent surgery for tympanosclerotic stapes fixation between January 1992 and October 1999. Stapedotomy with vein graft interposition and reconstruction with a Teflon piston, or a total prosthesis in cases of incudal erosion. Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone conduction threshold, air conduction threshold, and Glasgow Benefit Plot were measured. Postoperative air-bone gap closure to within 10 dB was achieved in 39% of cases. An air-bone gap less than 20 dB was obtained in 70% of cases. Significant postoperative improvement of air conduction thresholds, more than 20 dB, was found in 46% of cases. The postoperative bone conduction thresholds were unchanged in 92% of cases. No significant sensorineural hearing loss was seen in this series. This series demonstrates that safe and successful stapedotomy is possible if certain rules are respected.