Management of otosclerosis remains challenging even in an era with more than 90% success rates and advancing technology and research. The controversial issues will always be defined by how different management and treatment improve our results and change our indications for therapy. Our management of these issues may not yet be through its final modifications but it currently provides a high degree of success and satisfaction for both patients and surgeons.


Lippy and Daniels—CHAPTER 43

1. House HP. The evolution of otosclerosis surgery. Otolaryngol Clin North Am 1993;26:323-333

2. Shea J Jr. Fenestration of the oval window. Ann Otol Rhinol Laryngol 1958;67:932-951

3. McGee TM, Diaz-Ordaz E, Kartush J. The role of KTP laser in revision stapedectomy. Otolaryngol Head Neck Surg 1993;109:839-843

4. Haberkamp TJ, Harvey SA, Khafagy Y. Revision stapedectomy with and without the CO2 laser: an analysis of results. Am J Otol 1996;17:225-229

5. Lundy LB. Otosclerosis update. Otolaryngol Clin North Am 1996;29:257-263

6. Langman AW, Lindeman RC. Revision stapedectomy. Laryngoscope 1993;103:954-958

7. Perkins R. Laser stapedotomy. In: Brackmann DE, ed. Otologic Surgery. Philadelphia: WB Saunders; 1994:314-329

8. Kodali S, Harvey SA, Prieto TE. Thermal effects of laser stapedectomy in an animal model: CO2 vs KTP. Laryngoscope 1997;107:1445-1450

9. Wong BJ, Neev J, van Gemert MJ. Surface temperature distributions in carbon dioxide, argon, and KTP (Nd:Yag) laser ablated otic capsule and calvarial bone. Am J Otol 1997; 18:766-772

10. Causse JB, Gherini S, Horn KL. Surgical treatment of stapes fixation by fiberoptic argon laser stapedotomy with reconstruction of the annular ligament. Otolaryngol Clin North Am 1993;26:395-415

11. Lippy WH, Burkey JM, Fucci MJ, et al. Stapedectomy in the elderly. Am J Otol 1996;17:831-834

12. Lippy WH, Burkey JM, Schuring AG, Rizer FM. Stapedectomy in children: short- and long-term results. Laryngoscope. 1998;108:569-572

13. Millman B, Giddings NA, Cole JM. Long-term follow-up of stapedectomy in children and adolescents. Otolaryngol Head Neck Surg 1996;115:78-81

14. Issa TK, Bahgat MA, Linthicum FH Jr, House HP. The effect of stapedectomy on hearing of patients with otosclerosis and Meniere's disease. Am J Otol 1983;4:323-326

15. Thringer JK, Arriaga MA. Stapedectomy in military aircrew. Otolaryngol Head Neck Surg 1998;118:9-14

16. Katzav J, Lippy WH, Shamiss A, Davidson BZ. Stapedectomy in combat pilots. Am J Otol 1996;17:847-849

17. Clinical Indicators Compendium. Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., Washington, D.C. Otolaryngol Head Neck Surg 1992;107:141-145

18. Lippy WH, Burkey JM, Schuring AG, Rizer FM. Stapedectomy in patients with small air-bone gaps. Laryngoscope 1997;107:919-922

19. Daniels RL, Lippy WH. The other ear—findings and results in 3600 bilateral stapedectomies. COSM 1999

20. Lippy WH, Schuring AG. Stapedectomy revision of the wire-Gelfoam prosthesis. Otolaryngol Head Neck Surg 1983;91: 9-13

21. Lippy WH, Schuring AG. Stapedectomy revision following sensorineural hearing loss. Otolaryngol Head Neck Surg 1984;92:580-582

22. Lippy WH. Schuring AG, Ziv M. Stapedectomy revision. Am J Otol 1980;2:15-21

23. Rizer FM, Lippy WH, Schuring AG. Partial footplate removal in stapedectomy. Operative Techniques Otolaryngol Head Neck Surg 1998;9:13-19

24. Lippy WH. Special problems in otosclerosis surgery. In: Brackmann DE, ed. Otologic Surgery. Philadelphia: WB Saunders; 1994:347-355

25. Lippy WH, Schuring AG. Solving ossicular problems in stapedectomy. Laryngoscope 1983;93:214-216

26. Lippy WH, Schuring AG. Prosthesis for the problem incus in stapedectomy. Arch Otolaryngol 1974;100:237-239

27. Lippy WH, Schuring AG, Ziv M. Stapedectomy for otosclerosis with malleus fixation. Arch Otolaryngol 1978;104: 388-389

28. Lippy WH, Fucci MJ, Schuring AG, Rizer FM. Prosthesis on a mobilized stapes footplate. Am J Otol 1996;17:713-716

29. Rizer FM, Lippy WH. Evolution of techniques of stape-dectomy from the total stapedectomy to the small fenestra stapedectomy. Otolaryngol Clin North Am 1993;26: 443-451

30. Sedwick JD, Louden CL, Shelton C. Stapedectomy vs stape-dotomy: do you really need a laser? Arch (Otolaryngol 1997; 123:177-180

31. McGee TM. Comparison of small fenestra and total stapedectomy. Ann Otol Rhinol Laryngol 1981;90:633-636

32. Fisch U. Stapedotomy vs stapedectomy. Am J Otol 1982;4: 112-117

33. Cremers W, Beusen J, Huygen P. Hearing gain after stapedotomy, partial stapedectomy, or total stapedectomy for otosclerosis. Ann Otol Rhinol Laryngol 1991;100:959-961

34. Lippy WH, Schuring AG, Rizer FM. Intraoperative audiometry. Laryngoscope 1995;105:214-216

35. Causse JR, Causse JB, Uriel J, et al. Sodium fluoride therapy. Am J Otol 1993;14:482-490

36. House HP, Linthicum FH Jr. Sodium fluoride and the oto-sclerotic lesion. Arch Otolaryngol 1974;100:427-430

37. Shambaugh GE Jr, Causse J. Ten years experience with fluoride in otosclerotic (otospongiotic) patients. Ann Otol Rhinol Laryngol 1974;83:635-642

38. Forquer BD, Linthicum FH Jr, Bennett C. Sodium fluoride: effectiveness of treatment for cochlear otosclerosis. Am J Otol 1986;7:121-125

39. Bretlau P, Salomon G, Johnsen NJ. Otospongiosis and sodium fluoride: a clinical double-blind, placebo-controlled study on sodium fluoride treatment in otospongiosis. Am J Otol 1989;10:20-22

40. Kennedy DW, Hoffer ME, Holliday M. The effects of etidronate disodium on progressive hearing loss from otosclerosis. Otolaryngol Head Neck Surg 1993;109:461-467

41. Brookler KH, Tanyeri H. Etidronate for the neurologic symptoms of otosclerosis: preliminary study. Ear Nose Throat J 1997;76:371-381

Controversies about the management of otosclerosis, which began with the first report by Johannes Kessel in Jena in 18761 on stapedectomy, through the fenestration era, beginning in 1910,2 did not end with the resurrection of the stapedectomy operation by John Shea, Jr., in 1956.3 Once stapedectomy and reconstruction of the sound-conducting mechanism of the middle ear were demonstrated by surgeons all over the world to restore hearing in most patients (with only a small number made worse), the question of what operation to do was settled. Mobilization of the stapes and fenestration of the lateral semicircular canal were no longer performed, and everyone began to perform the stapedectomy operation. Now the controversies concern on whom to perform stapedectomy, at what age, what degree of hearing loss, whether to perform the procedure on the only hearing ear, how much of the footplate of the stapes to remove, how to seal the oval window, and how to reconstruct the sound-conducting mechanism of the middle ear. What to do after a good hearing improvement, whether or not to give sodium fluoride, when and if to operate on the other ear, when to recommend a hearing aid rather than stapedectomy, and other questions continue to be debated.

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