Stapedotomy or Stapedectomy: Does It Really Matter?

Introduction  Otosclerosis leads to stapes fixation and consequent conductive hearing loss. Surgery is the mainstay of treatment, and it can be achieved through small fenestra stapedotomy or stapedectomy. Despite the first being favored by most, evidence supporting its superiority over the latter remains inconclusive. Objective  To assess the hearing outcomes and complications of stapes surgery performed in a series of patients with otosclerosis and compare the results of stapedotomy with stapedectomy. Methods  A retrospective study of 134 ears in 125 otosclerosis patients undergoing primary stapes surgery was conducted. Patients underwent either stapedotomy or stapedectomy, and outcomes were compared using pre- and postoperative audiometric data and complication rates. Results  Most cases (81%) underwent stapedotomy. Both techniques resulted in significant improvement in air-bone gap (ABG) and speech recognition threshold (SRT) postoperatively, with no significant difference between them. Complication rates were comparable between techniques, with no statistical difference in postoperative complications. Conclusion  Both stapedotomy and stapedectomy offer favorable hearing outcomes with low complication rates in otosclerosis patients. While stapedotomy remains the preferred technique, if the initial plan shifts to a stapedectomy, surgeons should remain composed and confident in a good hearing outcome.