Factors affecting fenestration of the footplate in stapes surgery: effectiveness of Fisch's reversal steps stapedotomy.

OBJECTIVE:To analyze the factors affecting the fenestration of the footplate in stapes surgery and to evaluate the effectiveness of Fisch's reversal steps stapedotomy. STUDY DESIGN:Retrospective study. PATIENTS:A total of 191 patients with otosclerosis in whom 230 primary stapes surgeries were performed by 1 surgeon in 3 tertiary hospitals. MAIN OUTCOME MEASURE:Evaluation of factors affecting the fenestration of the footplate in stapes surgery by logistic regression analysis. RESULTS:Stapedotomy (small hole in stapes footplate) was performed in 148 ears (64.3%). Partial stapedectomy (half removal of stapes footplate) was performed in 65 ears (28.3%). Total stapedectomy (total removal of stapes footplate) was performed in 17 ears (7.4%). Stapedotomy could be performed in 72.1% of cases (75/104) in which the stapes suprastructure was removed after insertion of the prosthesis and in 57.9% of cases (73/126) in which the stapes suprastructure was removed before the insertion. Stapedotomy could be performed in 65.4% of cases (117/179) in which a 0.6-mm-thick Schuknecht-type Teflon wire piston was used and in 60.8% (31/51) in which a whole Teflon piston was used. Multivariate analysis of factors affect stapedotomy using logistic regression analysis showed that the surgical order of the removal of the stapes suprastructure and insertion of the prosthesis were the most important 2 factors. CONCLUSION:Fisch's reversal steps technique was useful in performing stapedotomy in all otosclerosis patients. Manipulation of the prosthesis when crimping it to the incus is also important. The prosthesis should be crimped onto the incus and inserted in the footplate opening gently and atraumatically.