40 YEARS OF STAPES SURGERY

Objective: This study reports the results of 14,449 stapedectomy opera tions performed during the past 40 years. Study Design: The study desi gn was a retrospective case review. Approximately 100 operations were selected from each of the past 40 years, for a total of 5,444 operatio ns, from which the results with the whale group were extrapolated.Sett ing: All operations were performed in a hospital during the first 30 y ears and in an ambulatory surgery center in the past 10 years. Patient s: All patients in the study were the private patients of the author a nd were operated on by him personally. These patients had otosclerosis only. Interventions: Stapedectomy was performed on all patients. Main Outcome Measures: The change in hearing after the operation was repor ted. Using the hearing of the average for 500, 1,000, and 2,000 Hz, th e criteria for success were defined as closure of the air-bone gap to 10 dB or less and no decline in speech discrimination of >10%. Results : In the primary stapedectomy group, success was achieved in 95.1% of ears after 1 year, 94.7% of ears after 2-5 years, and 62.5% after >30 years. In the revision stapedectomy group, success was achieved in 71. 1% after 1 year, 62.4% after 2-5 years, and 59.4% after 6-36 years. Co nclusions: The immediate success rate after primary and revision stape dectomy declines slowly over time, because of delayed conductive heari ng loss and further sensorineural hearing loss, mon than one would exp ect in matched control subjects without otosclerosis. Stapedectomy has stood the test of time as the first successful microsurgical operatio n.