Stapedotomy: Functional Results with Different Diameter Prostheses

Abstract

Developments in surgical technique and, more importantly, the use of increasingly sophisticated biocompatible prostheses have meant that good results can be achieved for otosclerosis sufferers in terms of restored hearing and very little postsurgical discomfort. We set out to assess whether the diameter of the prostheses used for stapedotomy (platinum piston/polytetrafluoroethylene, i.e. Teflon) has any effect on surgical outcome. Two groups of otosclerotic patients were selected, and these underwent stapedotomy surgery during the second phase of the disease. A piston-Teflon type prosthesis was used, 5.50 mm in terms of length but of different diameters (group A: 0.4 mm; group B: 0.6 mm). All the patients underwent the same pure-tone audiometry test before surgery, and then at 1 week and 1 month after surgery, to assess function. We compared air conduction after surgery with bone conduction before surgery. The data collected was analysed using the χ² (p < 0.05) test. This analysis showed that the results obtained with a 0.4-mm prosthesis or a 0.6-mm prosthesis are almost identical. There was no statistically significant difference in terms of hearing results when comparing either average tonal threshold or when analysing audiometric data frequency by frequency. It can be concluded, therefore, that in stapedotomy surgery, functional recovery is not affected by the diameter of the prosthesis used. A smaller diameter prosthesis is, however, the one of choice when the facial nerve is prominent or the oval window particularly narrow.

A systematic review of the effect of piston diameter in stapes surgery for otosclerosis on hearing results

“…; date of last search was February 14, 2015). After selection based on title and abstract, and subsequent full‐text screening, 20 articles were considered eligible for answering our question. One of these articles was excluded based on language (Russian).…”

“…The relevance was found to be high in 11 studies and moderate in nine studies . In the nine studies that were characterized by a moderate relevance, it was unclear whether revision stapedotomies were included in the analyses.…”

“…Five studies did not report our primary or secondary outcome measure, but did report pure‐tone audiometric results. Cavaliere et al analyzed the difference between preoperative bone‐conduction thresholds and postoperative air‐conduction thresholds per frequency at 1‐week and 1‐month follow‐up. No statistically significant differences were found between the use of a 0.4‐mm‐diameter Teflon piston and a 0.6‐mm‐diameter Teflon piston.…”

“…Differences in fenestration size, prosthesis material, and preoperative pure‐tone thresholds between the two treatment groups may influence success rates. Fenestration sizes were not mentioned in four studies . In six studies, the diameter of the fenestration was slightly larger than the prosthesis diameter in both treatment arms, and thus correlated to prosthesis diameter.…”

“…Teig and Lindemann reported that both mean preoperative air‐conduction thresholds and bone‐conduction thresholds were not statistically significantly different between the treatment arms . In the remaining studies, it is unclear whether differences in preoperative hearing thresholds might have influenced the success percentages and/or mean postoperative air‐bone gaps …”