From posterior crus stapedectomy to 0.6 mm stapedotomy--towards reliability in otosclerosis surgery

In the 1980s, in Oulu, clinical otosclerosis was primarily managed with posterior crus stapedectomy and in the 1990s, the method was changed to stapedotomy. This retrospective study was carried out to assess the results of different methods of stapes surgery in the hands of one surgeon. Subsequent primary stapes operations in 1989-1990 (91 operations including 74 posterior crus stapedectomies and 1 Causse stapedotomy) and in 1993-1994 (117 operations including 1 posterior crus stapedectomy, 95 Causse pistons) were analysed. Changes in air and bone conduction thresholds were compared 5 weeks, 7 months and 19 or more months postoperatively. There was a significant difference in hearing (air-conduction-AC and bone-conduction-BC) in favor of Causse 0.6 mm teflon piston prostheses as compared to posterior crus stapedotomies at 7 months and 19 or more months. Likewise, the 4 kHz gain at the same time was also significantly better with Causse 0.6 mm all teflon piston. At 5 weeks, 81% of posterior crus stapedectomies and 78% of Causse stapedotomies had air conduction thresholds within 10 dB of preoperative bone conduction. However, at 7 months, the corresponding figures were 68% and 89%. Re-operations were performed in 26.7% posterior crus stapedectomies but only in 1% Causse 0.6 mm teflon piston stapedotomies. In the hands of the senior author (KL), the change from posterior crus stapedectomy technique to stapedotomy with 0.6 mm Causse teflon piston in primary stapes surgery proved to be successful. Surprisingly, the AC and BC hearing in the Causse stapedotomy group kept on improving during the follow-up.