Stapedotomy Versus Stapedectomy
Otology & Neurotology (2009) recently published a Commentary by Ugo Fisch, MD, in which he commented on his original paper (based on 392 ears) from 1982 titled "Stapedotomy versus Stapedectomy." The 2009 Commentary represents reflections and expansions from a very well-known and highly respected otologist, as he reviews the core topic and its components, as well as his own work from almost three decades earlier.
Note: A limited opening/hole within the central footplate of the stapes (accomplished via laser or manually with a drill) is referred to as "stapedotomy." Total or subtotal removal of the stapes footplate (usually accomplished manually) is referred to as "stapedectomy."
Among the comments offered in 2009:
Manual footplate perforation is preferred over laser based on consistent availability of equipment. Fisch reports there is no proof that laser results are better than manually-derived results. Fisch advocates leaving the lenticular process (the articulation point between the stapes and the incus) intact during surgery as the prosthesis can be perfectly molded around the incus. Determining the length of the prosthesis is still key to a successful operation. Fisch refers to Paum and notes that the distance is optimal when 0.5mm is added to the distance from the lateral surface of the incus to the footplate. Precise crimping of the stapes prosthesis as well as maximal exposure is achieved through the "endaural approach" and is advocated by Fisch for incus and malleus stapedotomy.
In the original article (1981), Fisch stated that stapedotomy was the operation of choice as it is less traumatic and achieves better hearing results. In 2009, he added that "simplification of means and methods minimizes the intraoperative and postoperative complications."
For More Information, References, and Recommendations
Fisch U. (1982) Stapedotomy versus Stapedectomy. Otology & Neurotology 4:112-117.
Fisch U (2009) Commentary- Stapedotomy versus Stapedectomy. Otology & Neurotology 30(8):1166-1167.
Paum PB, Pollak AM, Fisch U. (1991) Utricle, Saccule and Cochlear Duct in Relation to Stapedotomy. A Histologic Temporal Bone Study. Ann Oto Rhinol Laryngol 12.