Conclusion

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.

REFERENCES

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

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

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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

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

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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

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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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