Piston diameter in stapes surgery. Does it have a bearing?

Comparative study showing relevance of prosthesis diameter and hearing outcome in stapes surgery

“…In our study, there were more number of male patients than female patients (1.6:1) this is contrary to previous studies Gupta et al 8,9 This was probably due to fitness for duty in our organization.…”

“…Some studies had similar findings as our study (suggesting there is no significant difference in outcome with use of different diameter of prosthesis), Gupta et al, Gristwood et al, Cavaliere et al, Faranesh et al, Wegner et al and other studies had findings contrary to our study. 6,8,[12][13][14] They preferred use of larger diameter of piston over smaller, The better result with larger diameter was assumed on basis of mathematical models on mechanical and acoustic analysis middle ear reconstruction (and on the biomechanics of stapedotomy), which seemed to indicate that a larger diameter piston is associated with better sound transmission to the inner ear. 21,22 Experimental study on temporal bone model by Sim et al, demonstrated that a larger diameter prosthesis increased the round window velocities, had better volume displacement at round window and better sound transmission slightly improving hearing results.…”

The Effect of Piston Diameter in Stapedotomy for Otosclerosis

“…The majority of studies do not show a statistically significant and/or clinically relevant difference in air-bone gap closure to 10 dB or less when comparing two differently sized pistons (20)(21)(22)(23)(24). Studies evaluating the effect of piston diameter on mean postoperative air-bone gap report differences of 3 dB in favor of a smaller-diameter piston to 3 dB in favor of a largerdiameter piston (20,21,23,25). In clinical studies, however, it is very difficult to remove the effects of numerous confounding variables.…”