Long-term hearing results following stapedotomy

Stapedotomy, or small fenestra stapes surgery, offers several advantages over total stapedectomy, including less postoperative vertigo and better closure of the air-bone gap at higher frequencies. Although early postoperative results are encouraging for the small fenestra technique, few data are available for longer follow-up periods. In this retrospective study, the hearing results of 35 stapedotomy patients, representing 37 operated ears, were analyzed. Each patient had a follow-up period ranging from 5 to 11 years, with audiograms obtained preoperatively, postoperatively, and at the longterm follow-up intervals. Data obtained included air conduction, bone conduction, and speech discrimination for both ears. The long-term hearing results of the small fenestra technique compared favorably to those reported for total stapedectomy, although a statistical analysis is difficult because of the differing methods used to report the data. Results showed a linear deterioration of air conduction thresholds over time, which corresponded to a decrease of bone conduction thresholds in the operated ear. The rate of deterioration of bone conduction appeared to be the same as that associated with presbycusis alone. After good initial closure of the air-bone gap at all measured frequencies, there was no significant increase in conductive hearing loss with time. In the nonoperated ear, the bone conduction for the speech frequencies deteriorated at a rate significantly higher than that for the operated ear and was probably related to Carhart's effect.