Background/Objectives: Since we started endoscopic stapes surgery, we have frequently noticed a white spot (WS) with a clear boundary on the bone surface around the fissula ante fenestrum (FAF) in otosclerosis cases. We investigated the significance of this surgical finding. Methods: We enrolled 27 cases of otosclerosis and 28 control cases of conductive hearing loss due to pathologies other than otosclerosis, both operated on endoscopically at the University of Tokyo Hospital. We retrospectively reviewed surgical videos to determine whether WS was present or absent. We examined the incidence of WS in otosclerosis cases and the controls and also in cases of otosclerosis, the presence or absence of WS was compared with the preoperative hearing level, preoperative air-bone gap, vasodilatation on the promontory, and a low-density area on high-resolution computed tomography (HRCT). Results: WS was present in 11 (41%) of 27 cases of otosclerosis but none in 28 control cases. There were no significant differences in patients' age and gender, the incidence of vasodilatation on the promontory, preoperative hearing level, or preoperative air-bone gap between otosclerosis cases with and without WS. Although a hypodense focus anterior to the oval window was more frequently present on HRCT in otosclerosis cases with WS (82%) than those without WS (56%), the difference in the incidence failed to reach significance (p = 0.10). Conclusions: We observed WS around the FAF only in cases of otosclerosis, indicating that WS is unique in otosclerosis. WS did not correlate with vasodilatation on the promontory, preoperative hearing level, or air-bone gap. A hypodense focus anterior to the oval window on HRCT tends to be more common in otosclerosis cases with WS.

To evaluate with a new otologic database the results of primary stapes surgery for otosclerosis with up to 14 years of follow-up in a consecutive series of 2,525 patients operated on by the same surgeon with the same technique (stapedotomy and vein graft interposition) and to provide online access to the complete data of this study for the reviewers. To study the effect of specific operative findings (obliterative otosclerosis and simultaneous malleus ankylosis) and age at the time of surgery on the long-term outcome.

Prospective clinical study using a new computerized otologic database.

: Tertiary referral center.

Two thousand five hundred twenty-five patients who underwent 3,050 stapedotomies for otosclerotic stapes fixation were enrolled in this study from January 1991 to December 2004. Separate analyses were made for two unique pathologies (92 cases of obliterative otosclerosis and 19 cases of simultaneous malleus ankylosis) diagnosed during surgery and for patients in two age brackets (<or=18 yr [28 patients] and >or=65 yr [302 patients]).

Stapedotomy with vein graft interposition and reconstruction with either a Teflon piston, a bucket handle prosthesis, or a total prosthesis.

Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap (ABG), bone-conduction thresholds, and air-conduction thresholds were all assessed. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months and then annually for 14 years.

Overall, the postoperative ABG was closed to 10 dB in 94.2% of cases. The mean four-frequency postoperative ABG was 1.7 dB compared with 25.6 dB preoperatively. The mean four-frequency bone-conduction thresholds were unchanged postoperatively. A significant postoperative sensorineural hearing loss (SNHL; >15 dB) was seen in 0.5% of cases in this series. Postoperative ABG was achieved to within 10 dB in 95% of cases of obliterative otosclerosis and in 64.7% of cases of simultaneous malleus ankylosis. A significant postoperative SNHL (>15 dB) was seen in 4.8% of cases of obliterative otosclerosis and was not observed in any cases of simultaneous malleus ankylosis. Postoperative ABG was achieved to within 10 dB in 93.5% of cases in the pediatric series and in 94.5% of cases in the senior series. A significant postoperative SNHL (>15 dB) was seen in 0.7% of cases in the senior group but was not observed in the children.

Using a new otologic database, our series confirms that stapedotomy with vein graft interposition for otosclerotic stapes fixation is a safe and successful treatment for long-term hearing improvement. The deterioration in hearing with time after stapedotomy did not exceed the rate of hearing loss because of presbyacusis. Therefore, argon laser stapedotomy with vein graft interposition is our preferred surgical technique in the treatment of otosclerosis. Obliterative otosclerosis and simultaneous malleus ankylosis may be encountered during stapedotomy. Our study shows that reasonable success rates can still be expected in these situations. Stapedotomy results in the elderly and in children are comparable to those obtained in patients of other groups of age undergoing surgery for otosclerosis without an increased risk for complications.

The focus of this paper is on the changing patterns of presentation of otosclerosis over the past 37 years.

Retrospective chart review.

Private otology practice.

Randomized selection of 400 patients (100 per decade) from 15,372 who underwent stapedectomy over the past four decades.

Extent of cochlear involvement, bilaterality of disease, length of history, degree of hearing loss, and pathological findings are noted.

The decreasing incidence of footplates necessitating drillouts is discussed. Changing audiometric patterns at presentation such as decreased pure-tone average hearing thresholds and smaller air-bone gaps are also reviewed.

This review demonstrates the changing patterns of presentation of otosclerosis over the past 37 years and will help guide the stapes surgeon into the year 2000.

From January 1990 to December 1996, 293 primary stapedectomies for otosclerosis were performed, among which 14 had obliterative otosclerosis (4.7 per cent). Probability of bilateral obliterative disease was 50 per cent. With this particular condition, a drill-out procedure was used to perform either a stapedectomy or a stapedotomy. In two patients with bilateral 'far-advanced otosclerosis', surgery was effective in enabling the patient to benefit from hearing-aids. In patients with a measurable hearing-loss, an air-bone gap closure to within 10 dB was achieved in 62.5 per cent of the cases and to within 10-20 dB in 37.5 per cent of the cases, with no deterioration of air-conduction thresholds at 8 kHz. A mild sensorineural hearing loss at 4 kHz was observed in 25 per cent of the cases. There was no statistical difference between stapedectomy and stapedotomy. According to these results, the drill-out technique is a safe and effective procedure in cases of obliterative otosclerosis.