Stapedectomy

I would now like to demonstrate the endoscopic stapedectomy technique. Studies between stapedectomy versus stapedotomy have not demonstrated a difference in the audiologic outcomes. Therefore, it largely comes down to the surgeon’s preference.

The surgical steps unique to a stapedectomy are highlighted in orange, my personal preferences is for the stapedotomy technique. However, if the stapes footplate were to become loose or, say, avulsed during a revision surgery, knowledge of the stapedectomy technique is critical to produce a good outcome.

Let’s look at case number 4. This is a right ear. I began the surgery with the intention of using a stapedotomy technique. During the stapedotomy, the footplate was noted to be loose but not displaced into the vestibule. The rosette pattern was changed to a straight line across the anterior aspect of the footplate. This enabled delicate removal of the posterior aspect of the footplate.

The perichondrial graft was harvested prior to footplate removal so that it can be quickly placed over the exposed vestibule. The graft should be centered over the vestibule to protect it during prosthesis placement. A bucket handle or modified bucket handle prosthesis should be used with the stapedotomy technique. In this case, I chose a bucket handle from Grace Medical. This prosthesis secures itself to the incus by gentle rotation of the handle portion onto the long process.