Stapedectomy in tympanosclerosis. A report of 67 cases

Stapedectomy was performed in sixty-seven ears with tympanosclerotic footplate fixation. This was confined to the footplate in 90% of ears, and there was an association with cholesteatoma and chronic infection. Large fenestra stapedectomy was performed in 91% of cases and the surgical procedure performed was tympanoplasty in 91% of cases. Three cases (4.5%) suffered a dead ear by three years following the procedure, but only one immediately. A variety of surgical procedures were used to reconstruct the tympanic membrane to oval window connection, and the air-bone gap did not depend on the choice of prosthesis in the short term. Retention of the incus led to later increasing air-bone gap, probably due to refixation by tympanosclerosis. Long-term results are analyzed for each method of reconstruction and each category of ossicular status identified at surgery. Small fenestra procedures produced less cochlear hearing loss at high frequencies. Surgical technique is discussed with reference to the pathophysiology of tympanosclerosis, and the role of hearing aids is considered.