Otosclerosis Management

"The size of the footplate fenestra or amount of footplate removed during stapedectomy for optimal performance and minimal complication has been evaluated by several studies. The general consensus is that there are probably no significant differences for overall performance in speech frequencies between stapedectomy and stapedotomy (fenestra size), but there may be a lower incidence of SNHL with stapedotomy."

William H. Lippy

"In a revision operation, it is important to avoid (1) penetrating the lining membrane of the vestibule to open the oval window, (2) removing a wire from beneath the lining membrane of the vestibule, or (3) reopening the oval window if closed by regrowth of otosclerotic bone."

"Use of a laser for refenestration of the oval window permits precise, controlled, atraumatic removal of connective tissue without mechanical forces being exerted into the inner ear. We feel strongly that the benefit of modern otologic lasers to revision stapes surgery is so great that we would not begin a revision procedure without the availability of a laser."

Karl L. Horn

Otosclerosis Management

William H. Lippy and Robert L. Daniels

CHAPTER 43

Otosclerosis is a disease that has seen its share of controversy over the past 40 years. It now represents a readily diagnosable and treatable process in which the surgical techniques for correction with some variability have been nearly perfected. Even now, however, some areas of controversy remain in the management of otosclerosis, specifically in patient selection for therapy, in treatment options, and in surgical techniques. Controversies in patient selection include determining the candidacy of groups that have unique issues that define the limits of intervention, such as children, the elderly, aviators and pilots, patients with small air-bone gaps, and patients with coexisting endolymphatic hydrops. Other issues include selecting patients for revision stapedectomy and anticipating problems that can be encountered in these cases. Differing opinions exist with regard to prosthesis choice, use or nonuse of tissue grafts, laser instrumentation, management of a mobile footplate, type of anesthesia, and amount of footplate removed. Finally, for some the medical management of otosclerosis and the use of fluoride or biphosphonates remains controversial. We present a discussion of these topics and our management of otosclerosis.

0 0

Post a comment