Posterior crus stapedectomy: An obsolete method in otosclerosis surgery?

Background: Stapedectomy and stapedotomy with interposition of prostheses a re the methods of choice for surgical treatment of otosclerosis. For the pr esent study we resumed and reevaluated the posterior crus stapedectomy, a m ethod based on the principal of renouncing a prosthesis by cutting the post erior crus of the stapes close to the footplate and the anterior crus close to the stapes head. Methods: The posterior crus is temporarily transposed with the incudostapedial joint remaining intact. After performance of plati nectomy and sealing of the oval window with fascia it is repositioned onto the center of the window. Results: 19 of 20 ears operated on applying this technique showed good results (closure of air bone gap) after a mean follow up of 24.6 months. One patient showed persistence of air bone gap of 32.5 dB. Revision surgery revealed that the posterior crus had migrated to the p osterior rim of the oval window. No inner ear affection, perilymph fistula or sensorineural hearing loss were observed. Conclusions: The major advanta ge of this technique is the avoidance of incus necrosis and foreign body re actions related to the material of the prosthesis. Disadvantages are techni cal plus the longer duration of the procedure.