Stapes Surgery: National Survey of British Otologists

Abstract

Objective: No standardized treatment protocols are available with regard to stapes surgery in the UK. We have therefore investigated individual stapes surgery practice. Method: Postal questionnaire to all stapes-performing otologists in UK. Questionnaire designed to address the following issues with stapes surgery: preferred technique, hearing aid trial, unilateral and bilateral surgery, prosthesis type, daycase preference, use of laser, covering of fenestration, gusher management, revision surgery, postopeartive flying time, facial nerve overhanging issues,and training juniors. Results: Of the questionnaires we received (182/197), 77 surgeons perform 6-15 operations/year, most (107) under GA. 123 advise stapes surgery in unilateral disease. 119 always advise patients about trying a hearing aid. 130 perform second side stapes surgery and most wait for at least 6 months for second side surgery. Stapedotomy is preferred (123), stapedectomy (11). Cause prosthesis is the most common. 57 always, and 47 never use a vein-graft. 67 use laser. 64 prefer daycase surgery. 37 would abandon surgery for a 50% or more overhanging facial nerve. 34 have encountered a “gusher.” 112 would recommend revision surgery. Most would advise patients “flying” after 6 weeks. Conclusion: In UK, the majority prefer GA, an overnight stay, a hearing aid trial, carrying out surgery in unilateral disease, 2nd side surgery, stapedotomy, inserting the prosthesis after removal of the stapes, advise revision surgery in conductive loss, and are willing to train trainees with an otological interest.