Stapedectomy

K. J. Lee

The most important aspect of stapes surgery is careful preoperative selection of surgical candidates, meticulous hemostasis, and careful identification of anatomical landmarks.

• The otolaryngologist must use tuning forks to confirm the results of audiologic testing prior to surgery. Both the 512 and 1024 Hz forks are used.
  
• The 512 Hz tuning fork gives a negative result if the air–bone gap is greater than 25 dB.
  
• The 1024 Hz tuning fork is negative if the air–bone gap is greater than 30 dB.
  
• The 256 Hz fork can be less accurate because it tests low frequencies, which are the same as the ambient noise in an office. More importantly, the 256 Hz fork gives a negative result if the air–bone gap is greater than only 15 dB. A 15 dB air–bone gap should never be an indication for a surgical procedure to improve hearing. Stapedectomy should be performed when the air–bone gap is greater than 25 dB.

• When a patient has Meniere’s disease, there is swelling of the endolymphatic space, or endolymphatic hydrops. During stapedectomy, the saccule may be punctured, which can result in profound sensorineural hearing loss. In rare instances, when a patient has both otosclerosis and Meniere’s disease, I choose not to operate and instead recommend a hearing aid.

• If the patient has a small ear canal or exostoses, the operation should be staged. The canalplasty should be done first, enlarging the canal and allowing it to heal. Three to 6 months later, the stapedectomy is performed.