Small Fenestra Stapedotomy Versus Large Fenestra Stapedectomy in Improving Hearing Ability in Patients with Otosclerosis: Our 10 Years Experience

  • Renuka BaluEmail author
  • Madhumita Kumar
  • Prem Govindan Nair
  • Suman Ravi John
  • Sreejith Sreekumar
Original Article


The aim of this study was to review the experience with surgical treatment of otosclerosis over the last 10 years at Amrita Institute of Medical Sciences and Research Centre and to compare it with reported outcomes. A total of 125 patients who had reported between January 2008 and June 2018 were selected for the study. The inclusion criteria for the study included the age group 15–60 years, conductive hearing loss with intact tympanic membrane and an air–bone–gap (ABG) of more than 30 dB. The exclusion criteria included patients below 15 years of age and above 60 years of age, patients with chronic otitis media and the cases of revision stapes surgery. Audiological evaluation was conducted prior to the surgery and post operative audiological evaluation was also performed after 1 month to understand the difference in hearing. In all cases the same surgical technique was used, only the dimension of the foot plate removed varied. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) (version windows base system, SPSS Inc. Chicago IL USA) software. Mean age in years who underwent surgery is 37.8 ± 11.4 and duration of disease in months median 36 months (range 1–120 months). Of the 125 patients (42% males and 58% females), 73 patients underwent large fenestra stapedotomy, and 52 patients underwent small fenestra stapedotomy. There was significant improvement in the following hearing parameters studied (puretone average of air conduction thresholds-PTA, ABG) in both the groups after surgery. There was no significant difference between the small fenestra and large fenestra groups with respect to improvement in PTA and ABG. On comparison of SDS (pre and post surgery) statistically significant difference was noted only in small fenestra group. However, this difference of SDS was not significant in between group comparison (stapedotomy versus stapedectomy). In summary both techniques are safe and effective treatment for conductive hearing loss in otosclerosis patients. There appears to be no deleterious effects of either procedures on hearing function. Similar results can be obtained in experienced hands using either technique. The absence of serious complications makes it reasonable to perform stapes surgery in both ears in patients with bilateral otosclerosis with conductive hearing loss.


Otosclerosis Conductive hearing loss Stapes surgery Air–bone–gap 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was presented and was approved by ethical committee.


  1. 1.
    Schuknecht HF (1974) Pathology of the ear. Harvard University Press, Cambridge, pp 351–373Google Scholar
  2. 2.
    Moumoulidis I, Axon P, Baguley D, Reid E (2007) A review on the genetics of otosclerosis. Clin Otolaryngol 32(4):239–247CrossRefGoogle Scholar
  3. 3.
    Arnold W, Friedmann I (1987) Detection of measles and rubella specific antigens in the endochondral ossification zone in otosclerosis. Laryngol Rhinol Otol 66(4):167–171CrossRefGoogle Scholar
  4. 4.
    Precechtel A (1967) Determination of the effect of pregnancy on activation of otosclerosis. Acta Otolaryngol 63(2):121–127CrossRefGoogle Scholar
  5. 5.
    Yoo TJ (1984) Etiopathogenesis of otosclerosis: a hypothesis. Ann Otol Rhinol Laryngol 93(1 Pt1):28–33CrossRefGoogle Scholar
  6. 6.
    Sabitha R, Ramalingam R, Ramalingam KK, Sivakumaran TA, Ramesh A (1997) Genetics of otosclerosis. J Laryngol Otol 109(2):109–112CrossRefGoogle Scholar
  7. 7.
    Altman F, Glasgold A, Macduff JP (1967) The incidence of otosclerosis as related to race and sex. Ann Otol Rhinol Laryngol 76(2):377–392CrossRefGoogle Scholar
  8. 8.
    Karosi T, Sziklai I (2010) Etiopathogenesis of otosclerosis. Eur Arch Otorhinolaryngol 267:1337–1349CrossRefGoogle Scholar
  9. 9.
    Cajade FJ, Labellero T (2003) Epidemiological aspects of otosclerosis (1). Its frequency in comparison with other ear pathologies, incidence and prevalence. Ann Otorhinolaryngol Am 30(1):1–15Google Scholar
  10. 10.
    Arnold W, Busch R, Arnold A, Ritsher B, Neiss A (2007) The influence of measles vaccination on the incidence of otosclerosis in Germany. Eur Arch Otorhinolaryngol 264:741–748CrossRefGoogle Scholar
  11. 11.
    Redfors YD, Moller C (2011) Otosclerosis thirty year’s follow up after surgery. Ann Otol Rhinol Laryngol 120(9):608–614CrossRefGoogle Scholar
  12. 12.
    House JW, Cunningham CD, Cummings CW, Flint PW, Haughey BH, Niparko JK et al (eds) (2010) Cummings otolaryngology—head and neck surgery, 5th edn. Elsevier Mosby, Philadelphia, pp 2028–2035Google Scholar
  13. 13.
    Nemati S, Naghavil E, Kaemnejad E et al (2013) Middle ear exploration results in suspected otosclerosis cases: are ossicular and foot plate area anomalies rare? Iran J Otorhinolaryngol 25(72):155–159Google Scholar
  14. 14.
    Hueb MM, Goycoolea MV, Paparella MM, Oliveria JA (1991) Otosclerosis. Otolaryngol Head Neck Surg 105(3):396–405CrossRefGoogle Scholar
  15. 15.
    Oliveria CA (2007) How does stapes surgery influence severe disabling tinnitus in otosclerosis patients? Adv Otorhinolaryngol 65:343–347Google Scholar
  16. 16.
    Gristwood RE, Venables WN (2003) Otosclerosis and chronic tinnitus. Ann Otol Rhinol Laryngol 112(5):398–403CrossRefGoogle Scholar
  17. 17.
    Glasscock MEIII, Shambaugh GE Jr (2002) Surgery of the ear, 5th edn. W.B. Saunders, PhiladelphiaGoogle Scholar
  18. 18.
    Lippy WH, Burkey JM, Schuring AG, Rizer FM (1997) Stapedectomy in patients with small air-bone gap. Laryngoscope 107:919–922CrossRefGoogle Scholar
  19. 19.
    Wiet RJ, Raslan W, Shambaugh GE (1986) Otosclerosis 1981 to 1985. Our four-year review and current perspective. Am J Otol 7:221–228Google Scholar
  20. 20.
    House JW, Cunningham CDIII (2005) Otosclerosis. In: Cumming CW (ed) Otolaryngology head and neck surgery, 4th edn. Mosby, PhiladelphiaGoogle Scholar
  21. 21.
    Shea JJ (1956) Symposium on the operation for mobilization of the stapes in otosclerosis. Laryngoscope 66:729–784Google Scholar
  22. 22.
    House HP, Hansen MR, Al Dakhail AAA, House JW (2002) Stapedectomy versus stapedotomy: comparison of results with long term follow up. Laryngoscope 112(11):2046–2050CrossRefGoogle Scholar
  23. 23.
    Aarnisalo AA, Vasama JP, Hospu E, Ramsay H (2003) Long term hearing results after stapes surgery. A 20 yr follow up. Otol Neurotol 24(4):567–571CrossRefGoogle Scholar
  24. 24.
    Shea JJ Jr (1998) Forty years of stapes surgery. Am Otol 19(1):52–55Google Scholar
  25. 25.
    Vincent R, Sperling NM, Oates J, Jindal M (2006) Surgical findings and long-term hearing results in 3050 stapedectomies for primary otosclerosis: a prospective study with the otology-neurotology data base. Otol Neurotol 27(8):s25–s47CrossRefGoogle Scholar
  26. 26.
    Lippy WH, Battista RA, Bernholz I, Schuring AG, Burkey JM (2003) Twenty year review of revision stapedectomy. Otol Neurotol 24(4):560–566CrossRefGoogle Scholar
  27. 27.
    Constantidis I, Vaz F, Triaridis S, Fairley JW (2002) Causse laser stapedectomy. Results and patient’s satisfaction rate audit in a district general hospital. Hippokratia 6(1):15–18Google Scholar
  28. 28.
    Ramsay H, Palva T (1997) Success in surgery for otosclerosis: hearing improvement and other indicators. Am J Otolaryngol 18(1):23–28CrossRefGoogle Scholar
  29. 29.
    Salahuddin I, Salahuddin A (2002) Experience with stapedectomy in a developing country: a review of 200 cases. Ear Nose Throat J 81(8):548–552CrossRefGoogle Scholar
  30. 30.
    Simoncelli C, Ricci G, Trabalzini F, Gulla M, Molini E (2005) Stapes surgery: a review of 515 operations performed from 1998 to 2002. Mediterr J Otol 1:1–6Google Scholar
  31. 31.
    Morrison AW (1967) Genetic factors in otosclerosis. Ann R Coll Surg Engl 41:202–237Google Scholar
  32. 32.
    Mc Kenna MJ, Krisiansen AG, Bartley ML, Rogus JJ, Haines JL (1998) Association of COL1A1 and otosclerosis. Evidence for a shared genetic etiology with mild osteogenesis imperfect. Am J Otol 19:604–610Google Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  • Renuka Balu
    • 1
    Email author
  • Madhumita Kumar
    • 1
  • Prem Govindan Nair
    • 2
  • Suman Ravi John
    • 2
  • Sreejith Sreekumar
    • 3
  1. 1.Department of ENT, Amrita Institute of Medical Sciences and Research Centre (AIMS)Amrita Vishwa Vidyapeetham UniversityKochiIndia
  2. 2.Department of Speech Pathology and Audiology, AIMSAmrita Vishwa VidyapeethamKochiIndia
  3. 3.Clinfound Clinical Research ServicesKochiIndia

Personalised recommendations