Small fenestra stapedectomy. A preliminary report.

The small fenestra stapedectomy is based on a rationale of creating a more effective acoustical mechanical transmission system, while reducing potential labyrinthine disturbance. Surgical technique for the small fenestra stapedectomy is described, including the creation of the fenestra and the use of McGee stainless steel piston prosthesis with loose areolar tissue around the piston. Postoperative results are compared in a series of 100 cases, 50 having the small fenestra technique, SFT, and 50 having partial or total footplate removal procedure. Vestibular results demonstrate a noticeable reduction in postoperative complaints of balance disorders in the SFT patients. Hearing results, when compared between the two groups, show a statistically significant advantage for the SFT patients in postoperative high frequency threshold sensitivity and speech discrimination scores. Technical difficulties in creating the fenestra without fracturing the entire footplate are discussed and suggestions made for their avoidance. The advantages of lowered risk, based on reduced trauma to and contamination of the labyrinth, as well as improved high frequency hearing sensitivity and speech discrimination, support the use of this procedure and call for further investigation and development of its clinical potential.