A New Reversal Steps Stapedotomy

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Innovation

Background:

• Otosclerosis, a common cause of conductive hearing loss, involves abnormal bone growth affecting the stapes.
• Stapedotomy, a surgical procedure to restore hearing, carries risks of footplate complications.
• Current techniques for stapedotomy involve varying degrees of stapes superstructure removal.

Purpose of the Study:

• To investigate if preserving the stapes head during stapedotomy, as opposed to removing the entire superstructure, mitigates footplate complications.
• To compare hearing results between the two surgical approaches in patients with otosclerosis.

Main Methods:

• A prospective study involving 145 patients with otosclerosis.
• Patients were divided into two groups: Group 1 (n=75) underwent complete stapes superstructure removal, and Group 2 (n=70) had only the stapes head removed.
• Subgroup analysis was performed based on otosclerosis type (marginal, diffuse, biscuit).

Main Results:

• Footplate complications occurred in 9 cases in Group 1b (diffuse/biscuit otosclerosis with complete removal) but none in Group 2b (diffuse/biscuit otosclerosis with head removal only).
• Air-bone gap closure to within 10 dB was achieved in 65% of Group 1b cases compared to 94.7% in Group 2b.
• Both differences were statistically significant.

Conclusions:

• Removal of only the stapes head during stapedotomy is a safer technique, effectively preventing footplate complications.
• This modified approach significantly improves hearing outcomes, particularly in patients with diffuse and biscuit forms of otosclerosis.