FROM POSTERIOR CRUS STAPEDECTOMY TO 0.6 MM STAPEDOTOMY - TOWARDS RELIABILITY IN OTOSCLEROSIS SURGERY

In the 1980s, in Oulu, clinical otosclerosis was primarily managed wit h posterior crus stapedectomy and in the 1990s, the method was changed to stapedotomy. This retrospective study was carried cut to assess th e results of different methods of stapes surgery in the hands of one s urgeon. Subsequent primary stapes operations in 1989-1990 (91 operatio ns including 74 posterior crus stapedectomies and 1 Causse stapedotomy ) and in 1993-1994 (117 operations including 1 posterior crus stapedec tomy, 95 Causse pistons) were analysed. Changes in air and bone conduc tion thresholds were compared 5 weeks, 7 months and 19 or more months postoperatively. There was a significant difference in hearing (air-co nducticn-AC and bone-conduction-BC) in favor of Causse 0.6 mm teflon p iston prostheses as compared to posterior crus stapedotomies at 7 mont hs and 19 or more months. Likewise, the 4 kHz gain at the same time wa s also significantly better with Causse 0.6 mm all teflon piston. At 5 weeks, 81% of posterior crus stapedectomies and 78% of Causse stapedo tomies 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 stapedec tomies but only in 1% Causse 0.6 mm teflon piston stapedotomies. In th e hands of the senior author (KL), the change from posterior crus stap edectomy technique to stapedotomy with 0.6 mm Causse teflon piston in primary stapes surgery proved to be successful. Surprisingly, the AC a nd BC hearing in the Causse stapedotomy group kept on improving during the follow-up.