Total Stapedectomy

The history is critical in the diagnosis of otosclerosis. The typical symptoms of otosclerotic deafness are a gradually increasing unilateral or bilateral hearing loss, most frequently occurring between the end of the second and fifth decades; the presence of paracusis of Willis, and tinnitus. In two thirds of the patients, there is a family history of deafness with autosomal dominant pattern of transmission with 40% of penetrance. It occurs two times more frequently in women than in men and also is more common in whites than in other races. The progression of otosclerosis seems to be more rapid in younger patients. The hearing loss is also often rapidly progredsive during pregnancy and in women on estrogen therapy. Careful otomicroscopic examination can rule out other diagnoses that present with a conductive hearing loss such as the presence of a middle ear effusion, tympanosclerosis within the tympanic membrane, cholesteatoma, and tympanic membrane perforation. After obtaining a careful history and physical examination of the ear, complete audiologic and tuning fork examinations are used to diagnose otosclerosis. In every case, to confirm the presence and size of a genuine air-bone gap, the clinician should use the 256, 512, and 1,024 tuning fork Rinne's tests, with narrow-band masking of the opposite ear to ensure an accurate assessment of the ear under examination. Although the preoperative hearing tests indicate the degree of fixation, they do not predict the pattern and extent of oval window involvement by otosclerosis, which can be only determined at the time of surgical exploration. Stapedectomy is indicated when the stapes is fixed, as shown by an air-bone gap of 20 dB for the speech frequencies and a negative Rinne test result for the 512 tuning forks. It is also important to remember that in a certain subset of patients, profound bilateral sensorineural hearing loss may be caused by far advanced otosclerosis. 1-4 It is important that these patients are identified, because often their hearing can be improved through surgical correction so that serviceable aided hearing is possible. The diagnosis of far-advanced otosclerosis is made from the history and can