A Prospective Study of Efficacy of Small Fenestra Stapedotomy at a South Asian Center

Abstract

Introduction The best surgical treatment for otosclerosis is stapedotomy. Various methods are used for creating fenestra, including manual pick, laser, and Skeeter drill. In India, despite several studies on the hearing outcomes of otosclerosis surgery, there exist few studies on small fenestra stapedotomy performed using a microdrill. Hence, we designed this study with the objectives of examining the demographic profile, hearing improvement after surgery, anatomical variations encountered at surgery, effect of microdrill use on bone conduction (BC), and postoperative complications of small fenestra stapedotomy.

Methods A prospective study was conducted for 63 patients of otosclerosis. Stapedotomy was performed by the same surgeon on all patients by a transcanal approach under local anesthesia. Small fenestra stapedotomy was performed using Skeeter microdrill. The study proforma included sociodemographic profile, clinical history, examination, audiometry, surgical details, and postoperative findings. Descriptive statistics was used to analyze the data.

Results Our study demonstrated a male preponderance (58.7%) over females (41.3%). Of the study population, 31.7% reported a family history of otosclerosis, whereas nine (14.28%) individuals had a history of measles. All four different types of footplates were identified. Most of them were either type 1 (52.4%) or 2 (34.9%). In most cases, the diameter was 0.4 mm (96.8%), a majority of the cases having either 4.25 (22.2%) or 4.5 mm (63.5%) long piston. After stapes surgery, the mean ABG reduced from 39.48 (±9.17) to 13.89 (±7.99) dB. The mean worsening in postoperative BC was only 3.035 dB. Use of microdrill caused only a slight and statistically insignificant decline in BC. Anatomical variation of a narrow oval window niche may require drilling of the bone. In practice, this drilling does not adversely affect the BC of the patient. Some facial nerve variation (partially overhanging facial nerve and exposed facial nerve) may be encountered, but it does not affect the facial nerve function or hearing improvement. On rare occasions, facial paresis may occur on the fifth to sixth postoperative day, even without facial nerve handling. This can be managed conservatively with oral steroids with favorable results. Taste alterations are seen even when the chorda handling is minimal. Complaints are most common in the first few weeks after surgery. Over a 6-month period, only 5% of the patients who underwent surgery were found to have altered taste sensation.

Conclusion Microdrill-assisted small fenestra stapedotomy, performed under local anesthesia, with placement of a 0.4-mm Teflon piston for patients with otosclerosis produces excellent results. The complication rates are low, and the surgery has a positive impact on the patient's hearing.

Keywords

otosclerosis - skeeter drill - stapedotomy - teflon piston

• References

• 1 Sedwick JD, Louden CL, Shelton C. Stapedectomy vs stapedotomy. Do you really need a laser?. Arch Otolaryngol Head Neck Surg 1997; 123 (02) 177-180
• 2 Mangham Jr. CA. Reducing footplate complications in small fenestra microdrill stapedotomy. Am J Otol 1993; 14 (02) 118-121
• 3 Vincent R, Sperling NM, Oates J, Jindal M. Surgical findings and long-term hearing results in 3,050 stapedotomies for primary otosclerosis: a prospective study with the otology-neurotology database. Otol Neurotol 2006; 27 (08) (Suppl. 02) S25-S47
• 4 Gristwood RE, Venables WN. Analysis of long-term hearing gains after stapes surgery with piston reconstruction for otosclerosis. Ann Otol Rhinol Laryngol 2013; 122 (08) 500-510
• 5 Forton GE, Wuyts FL, Delsupehe KG, Verfaillie J, Loncke R. CO₂ laser-assisted stapedotomy combined with à Wengen titanium clip stapes prosthesis: superior short-term results. Otol Neurotol 2009; 30 (08) 1071-1078
• 6 Gjuric M. Microdrill versus perforator for stapedotomy. Clin Otolaryngol Allied Sci 1990; 15 (05) 411-413
• 7 Niedermeyer HP, Hausler R, Schwub D, Neuner NT, Busch R, Arnold W. Evidence of increased age in patients with otosclerosis. Arnold W, Hausler R. eds. Advances in Oto-Rhino-Laryngology. Basel, Switzerland: Karger; 2007: 17-24
• 8 Merchant SN, McKenna MJ, Browning GG, Rea PA, Tange RA. Otosclerosis. In: Gleeson M, Brownning GG, Burton MJ. et al eds. Scott-Brown's Otorhinolaryngology, Head and Neck Surgery. 7th ed.. Great Britain: Hodder Arnold; 2008: 3453-3485
• 9 Saeed SR, Briggs M, Lobo C, Al-Zoubi F, Ramsden RT, Read AP. The genetics of otosclerosis: pedigree studies and linkage analysis. In: Arnold W, Hausler R. eds. Advances in Oto-Rhino-Laryngology, vol 65. Basel, Switzerland: Karger; 2007: 75-85
• 10 Ayache D, Earally F, Elbaz P. Characteristics and postoperative course of tinnitus in otosclerosis. Otol Neurotol 2003; 24 (01) 48-51
• 11 Gristwood RE, Venables WN. Otosclerosis and chronic tinnitus. Ann Otol Rhinol Laryngol 2003; 112 (05) 398-403
• 12 Saunders NC, Fagan PA. Promontory drilling in stapedectomy: an anatomical study. Otol Neurotol 2006; 27 (06) 776-780
• 13 Ballester M, Blaser B, Häusler R. Stapedotomy and anatomical variations of the facial nerve [article in French]. Rev Laryngol Otol Rhinol (Bord) 2000; 121 (03) 181-186
• 14 Cuda D, Murri A, Mochi P, Solenghi T, Tinelli N. Microdrill, CO₂-laser, and piezoelectric stapedotomy: a comparative study. Otol Neurotol 2009; 30 (08) 1111-1115
• 15 Marchese MR, Paludetti G, De Corso E, Cianfrone F. Role of stapes surgery in improving hearing loss caused by otosclerosis. J Laryngol Otol 2007; 121 (05) 438-443
• 16 Marchese MR, Cianfrone F, Passali GC, Paludetti G. Hearing results after stapedotomy: role of the prosthesis diameter. Audiol Neurootol 2007; 12 (04) 221-225
• 17 Hausler R. Advances in stapes surgery. In: Jahnke K. ed. Middle Ear Surgery. USA: Thieme; 2003: 95-139
• 18 Handzel O, McKenna MJ. Surgery for otosclerosis. In: Gulya AJ, Minor LB, Poe DS. eds. Glasscock-Shambaugh Surgery of the Ear. 6th ed.. New Delhi, India: CBS Publishers and Distributors; 2010
• 19 Wiet RJ, Harvey SA, Bauer GP. Complications in stapes surgery. Options for prevention and management. Otolaryngol Clin North Am 1993; 26 (03) 471-490
• 20 Just T, Homoth J, Graumüller S, Pau HW. Taste disorders and recovery of the taste function after middle ear surgery [article in German]. Laryngorhinootologie 2003; 82 (07) 494-500