Stapedectomy versus stapedotomy: comparison of results with long-term follow-up

Abstract

Objective/hypothesis: To compare the effectiveness and long-term stability of hearing results between stapedectomy and small fenestra stapedotomy in patients with conductive hearing loss due to otosclerosis.

Study design: Retrospective review of prospectively collected audiometric data.

Methods: The hearing results and complication rates of 209 ears with long-term follow-up that underwent either stapedectomy or stapedotomy by the senior author (h.p.h.) between 1961 and 1989 were compared. Forty-two patients underwent stapedectomy in one ear and stapedotomy in the opposite ear, permitting a paired case review of the results in these patients. The techniques were compared with respect to initial and late hearing results and change of the results over time.

Results: Patients undergoing stapedectomy and stapedotomy were followed for an average of 11.5 and 6.0 years, respectively. There were no statistically significant differences in initial or late postoperative pure-tone average (PTA), PTA air-bone gap, speech discrimination scores, or incidence of sensorineural hearing loss between the two groups. Ears treated by stapedotomy showed statistically better initial and late postoperative 4-kHz air-conduction threshold and initial 4-kHz air-bone gap, but the gap difference was not significant with late follow-up. There was no significant difference in the percentage of patients with air-bone gap closure within 10 dB for any frequency other than 4 kHz at the initial postoperative test. Importantly, the successful outcomes in both groups were stable over long-term follow-up. Results were the same when comparing the two procedures in patients having undergone both.

Conclusion: These results show that, in the hands of an experienced surgeon, either technique provides satisfactory and stable long-term results.