Surgical Treatment of Otosclerosis(Special Lecture)

In 1982-1999, stapes surgery was performed on 57 ears of otosclerosis in our department. In 11 cases, stapes was totally removed and Gelfoam wire prosthesis was inserted. On the remaining 46 ears, small fenestra stapedectomy was carried out using Schuknecht Teflon-wire-piston as prosthesis. The recent surgical procedures are endaural incision, elevation tympanomeatal flap, confirming mesotympanum and removing posterior bony wall. Then, we can visualize long process of incus, incudo-stapedial joint, central part of footplate and tendon of stapedial muscle. After confirmation of fixation of stapes and mobility of long process of incus, separation of incudo-stapedial joint and cutting stapedial muscle tendon are done. Safety hole is made in the center of footplate using 0.8 mm hand drill (Nagashima Co.) or Buckingham hand drill (Richards Co.). The hole should be large enough to apply Teflon-wire-piston, that is, 0.8～1.0 mm as diameter. Then we cut anterior or posterior crus of stapes by Tabb crura nipper (Richards Co.), then quickly moved superstructure. In most cases, 4.25 mm length Teflon-wire-piston is applicable. The hook of wire is tightened around long process of incus by McGee wire tightner (Richards Co.). Good postoperative hearing was obtained due to small fenestra stapes surgery. In otosclerosis of oriental people, the sclerotic focus is so small that whole stapes tends to be luxated when we try to break superstructure. To avoid this situation we make a safety hole (0.8～1.0 mm in diameter) and cut anterior crus before breaking superstructure