Objective: To evaluate the functional results obtained after stapedotomy in patients affected by otosclerosis, according to the prosthesis diameter. Patients and Methods: A retrospective case review was performed. Two hundred and twelve consecutive ears in 132 patients affected by otosclerosis were operated on. All patients underwent primary small-fenestra stapedotomy. In 112 of the 212 stapedotomies (52.83%) the 0.6-mm piston (group A) and in 100 of the 212 stapedotomies (47.16%) the 0.4-mm piston (group B) were employed. Results: After surgery, the difference between the two groups in the air conduction improvement (21.04 dB group A vs. 11.14 dB group B) reached statistical significance (p < 0.05). In group A, the postoperative air conduction pure-tone average improvement obtained at 0.5, 1, and 2 kHz was statistically greater as compared with group B (p < 0.05). In group A the postoperative bone conduction pure-tone average decreased by 5.19 dB, whereas in group B it increased by 2.95 dB (p > 0.05). The incidence of ears with a postoperative bone conduction worsening >10 dB (sensorineural hearing loss) was lower in group B than in group A: 5 of 100 ears (5%) versus 9 of112 ears (8.03%) (p > 0.05). The postoperative air-bone gap was smaller in group A than in group B for all frequencies, but the difference can be considered significant at 1 and 2 kHz. The air-bone gap improvement in group A if compared with group B was statistically greater at 0.5, 1, and 2 kHz (p < 0.05). Conclusions: Our study suggests that an increase in piston diameter gives better results, especially at lower frequencies. The functional results obtained after stapedotomy confirm the advantageous effect of a larger piston diameter on hearing of the speech frequencies and support the opinion of a better clinical effect.

1.
Birch L, Elbrond O, Pedersen U: Hearing improvement after stapedectomy: up to 19 years’ follow-up period. J Laryngol Otol 1986;100:1–7.
2.
Boheim K, Nahler A, Schlagel H: Results with gold pistons in small-fenestra stapedectomy (in German). Otorhinolaryngol Nova 1997;7:235–240.
3.
Colletti V, Sittoni V, Fiorino FG: Stapedotomy with and without stapedius tendon preservation versus stapedectomy: long-term results. Am J Otol 1988;9:136–141.
4.
Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 1995;113:186–187.
5.
Conrad GJ: Collective stapedectomy: an approach to the numbers problem. J Laryngol Otol 1990;104:390–393.
6.
Donaldson JA, Snyder JM: Otosclerosis; in Cummings CW, Frederickson JM, Harker LA, Krause CJ, Schuller DE (eds): Otolaryngology – Head and Neck Surgery. St. Louis, Mosby-Yearbook, 1992, pp 2997–3016.
7.
Fisch U: Tympanoplasty and Stapedectomy: A Manual of Techniques. New York, Thieme-Stratton, 1980, pp 67–70.
8.
Fisch U: Stapedotomy versus stapedectomy. Am J Otol 1982;4:112–117.
9.
Fisch U: Ossiculoplasty; in Fisch U (ed): Tympanoplasty, Mastoidectomy, and Stapes Surgery. New York, Thieme, 1994, pp 263–267.
10.
Gristwood RE: Otosclerosis treatment; in Alberti PW, Ruben RJ (eds): Otologic Medicine and Surgery. New York, Churchill Livingstone, 1988, pp 1241–1259.
11.
Huttenbrink KB: Biomechanics of middle ear reconstruction (in German). Laryngorhinootologie 2000;79(Suppl 2):23–51.
12.
Jovanovic S, Schönfeld U, Scherer H: CO2 laser stapedotomy with the ‘one-shot’ technique – clinical results. Otolaryngol Head Neck Surg 2004;131:750–757.
13.
Kursten R, Schneider B, Zrunek M: Long-term results after stapedectomy versus stapedotomy. Am J Otol 1994;15: 804–806.
14.
Marchese MR, Paludetti G, De Corso E, Cianfrone F: Role of stapes surgery in improving hearing loss caused by otosclerosis. J Laryngol Otol 2006 Nov 20:1–6.
15.
Marquet J: ‘Stapedotomy’ technique and results. Am J Otol 1985;6: 63–67.
16.
Pedersen CB, Elbrond O: Comparative investigation of House and Fisch prostheses in stapedectomy. Acta Otolaryngol 1982;386 (Suppl):84–87.
17.
Rosowski JJ, Merchant SN: Mechanical and acoustic analysis of middle ear reconstruction. Am J Otol 1995;16:486–497.
18.
Sennaroglu L, Unal O, Sennaroglu G, Gursel B, Belgin E: Effect of Teflon piston diameter on hearing result after stapedotomy. Otolaryngol Head Neck Surg 2001;124:279–281.
19.
Shabana YK, Ghonim MR, Pedersen CB: Stapedotomy: does prosthesis diameter affect outcome? Clin Otolaryngol Allied Sci 1999;24:91–94.
20.
Shea JJ: Thirty years of stapes surgery. J Laryngol Otol 1988;102:14–19.
21.
Smyth GD, Hassard TH: Eighteen years experience in stapedectomy: the case for the small fenestra operation. Ann Otol Rhinol Laryngol Suppl 1978;87(3 Pt 2):3–36.
22.
Spandow O, Söderberg O, Bohlin L: Long-term results in otosclerotic patients operated by stapedectomy or stapedotomy. Scand Audiol 2000;29:186–190.
23.
Teig E, Lindeman H: Stapedotomy piston diameter: is bigger better? Otorhinolaryngol Nova 1999;9:252–256.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.