BONE-DUST-FREE LEMPERT FENESTRA NOV-OVALIS: A New Evolutionary Development of the Surgical Treatment of Clinical Otosclerosis

New model of superior semicircular canal dehiscence with reversible diagnostic findings characteristic of patients with the disorder

“…Although many others contributed to the development of the fenestration procedure, Julius Lempert was the first to develop the one-stage fenestration operation ( 26 – 30 ). As the technique evolved, two critical issues emerged related to preventing bone regrowth and closure of the new surgically created second mobile window: (1) avoiding a fenestration that was too small and (2) removing the bone dust from the area surrounding the fenestration ( 27 , 28 , 30 ). Dewyer et al reported the temporal bone pathology of a woman who had bilateral fenestration operations performed for otosclerosis ( 30 ).…”

“…This recovery in both groups suggested a conserved mechanism at work within both groups. As the major difference between the groups is the size of the fenestration we hypothesized that just like humans undergoing the old fenestration operations for otosclerosis, the site of bony dehiscence regrows into and obliterates the canal if the fenestration is too small or bone debris is left at the site of the fenestration (26)(27)(28)(29)(30). This is in contrast to patients who require direct surgical plugging of the SSCD to resolve the third window symptoms (14,15,21).…”

“…The lateral semicircular canal fenestration operation was developed to create a new second mobile window to improve the conductive hearing loss these patients experienced. Although many others contributed to the development of the fenestration procedure, Julius Lempert was the first to develop the one-stage fenestration operation (26)(27)(28)(29)(30). As the technique evolved, two critical issues emerged related to preventing bone regrowth and closure of the new surgically created second mobile window:…”

“…(1) avoiding a fenestration that was too small and (2) removing the bone dust from the area surrounding the fenestration (27,28,30). Dewyer et al reported the temporal bone pathology of a woman who had bilateral fenestration operations performed for otosclerosis (30).…”

Misuse of American Medical Association Data

“…In fact, this checkerboard chart does not provide any clearcut income level for definition of inability to pay the costs of a "serious" illness. When one considers the 4 [Oct.] 1936): All of the upper income classes (above $3,000) may be assumed to constitute no important problem. They are already cared for under the traditional system of private practice, with existing facilities.…”