Long-term results of small fenestra stapedectomy compared with large fenestra technique

Objectives/Hypothesis: A comparison is made of the postoperative long-term hearing results of small fenestra stapedectomy versus large fenestra techniques. Several reports in the literature favor improved hearing results in small fenestra stapedectomy compared with large fenestration and/or total stapedectomy. Methods: A retrospective review of 34 patients who had stapedectomy performed by the same surgeon between 1982 and 1992. All patients have been followed for up to 10 years postoperatively. Results: In 18 ears of 17 patients, surgery was performed with small fenestra technique, and 17 ears of 17 patients had total stapedectomy or posterior-half fenestration. After small fenestra stapedectomy, initial average air-bone gap at 500, 1000, and 2000 Hz was 9 dB hearing loss. Hearing thresholds at 4000 Hz deteriorated to 4% over the study period. Speech reception thresholds declined 15%. After total or posterior-half stapedectomy the average air-bone gap at 500, 1000, and 2000 Hz was 5 dB hearing loss. Hearing thresholds at 4000 Hz deteriorated 8% and 18% for the small fenestra and large fenestra groups, respectively, over time. Statistically, there was no difference in hearing deterioration rate between these two groups. Conclusions: An experienced surgeon can obtain excellent results using either large or small fenestra technique for otosclerosis. After initial successful closure of the air-bone gaps at all measured frequencies, hearing thresholds over the study period were stable for both groups.