Objective: Stapes surgery is considered an effective treatment in otosclerosis, but controversy remains regarding predictors of surgical outcome. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: One hundred sixty three cases of stapes surgery between 2012 and 2019 were reviewed. Main Outcome Measures: Primary outcome measures were relative hearing improvement (relHI), defined as preoperative minus postoperative air conduction divided by preoperative air-bone gap (ABG), as well as relative ABG closure (relABGc), defined as preoperative ABG minus postoperative ABG divided by preoperative ABG. Univariate and multivariate linear regression analyses were performed to determine independent predictors for these outcomes. Results: Higher preoperative bone conduction (BC) and primary surgery (compared with revision) were independently associated with increased relHI ( p ¼ 0.001 and p ¼ 0.004, respectively). Lower preoperative BC, higher preoperative ABG, primary surgery, and age were independently associated with increased relABGc ( p ¼ 0.0030, p < 0.001, p ¼ 0.0214, and p ¼ 0.0099, respectively). Sex did not predict surgical outcome. In patients with less than 20 dB preoperative ABG, likelihood of negative relABGc was increased (compared with 20-30 dB or >30 dB preoperative ABG, p ¼ 0.0292, Fisher's exact test). This tendency was not significant for relHI ( p ¼ 0.074). Conclusions: Our findings demonstrate that calculating HI and ABGc in relation to preoperative ABG can reliably predict outcomes of stapes surgery. Both primary and revision stapes surgery are effective treatment options, but relative improvement is higher in primary cases. Preoperative BC, preoperative ABG, and age predict surgical outcomes as well. Otosclerosis patients with low preoperative ABG, especially less than 20 dB, should be counseled and selected cautiously regarding stapes surgery.

Plastic reconstruction of facial skin defects after tumor surgery is a commonly accepted principle. However, healing by secondary intention is discussed controversially. Here we describe a series of 22 patients after full thickness resection of basal cell carcinoma who underwent wound healing by secondary intention. A semipermeable membrane was used for wound dressing, which was changed on a weekly basis. No antibiotics or pain killers were necessary. Defects up to 2 cm, particularly those of concave subunits of the midface, entirely closed within 4-6 weeks, and secondary wound healing led to excellent functional and aesthetic results. Thus, secondary wound healing is a safe, effective and economic alternative to surgical reconstruction in selected facial areas.