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Step-by-Step Stapedotomy through Transcanal Exclusive Endoscopic Approach
Published on: March 5, 2022
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Can the learning curve in stapes surgery predict future functional outcome?
1Clinic of Otorhinolaryngology; Università Cattolica di Roma, Italy.
Summary
Stapes surgery outcomes show a learning curve for new otologists, with variable results. Early cases achieved better hearing gain, but skills require significant development for consistent success.
Area of Science:
- Otolaryngology
- Surgical Education
- Audiology
Background:
- Stapes surgery volume has declined over 20 years, impacting surgical training.
- Inadequate exposure presents challenges for both novice surgeons and their mentors.
- This study examines the learning curve in stapes surgery for a young physician.
Purpose of the Study:
- To evaluate the outcomes of stapedotomy performed by a junior surgeon.
- To analyze the learning curve and identify critical skill acquisition points.
- To assess the impact of experience on functional hearing outcomes after stapes surgery.
Main Methods:
- Retrospective review of stapedotomy cases using "one-shot" CO2 Laser and a titanium-Teflon piston.
- Audiometric data (air conduction, bone conduction, air-bone gap) analyzed preoperatively and at mean 45-month follow-up.
- Calculation of postoperative hearing gain based on air-bone gap changes.
Main Results:
- Outcomes demonstrated variability, suggesting a learning curve without a clear endpoint.
- Initial surgeries showed a higher rate of complete air-bone gap closure.
- No instances of "dead ear" were recorded, indicating a baseline level of safety.
Conclusions:
- Stapes surgery exhibits a learning curve with significant outcome variability.
- Young otologists may face challenges due to the complexity and patient expectations.
- Stapes surgery is not recommended as an initial procedure for otologic trainees.
