Effects of fenestra size and piston diameter on the outcome of stapes surgery for clinical otosclerosis.
CONCLUSIONS: The diameter (0.6 or 0.8 mm) of the pistons selected for reconstruction after stapes surgery appears to have little effect on the outcome, except perhaps at 6 and 8 kHz, where the slim piston appeared to have a significant advantage. The size of the footplate fenestra is of paramount importance to the outcome. A small footplate fenestra has statistically significant advantages for hearing gain over all other sizes of fenestra (ie, total, three-quarter, or half removal of the footplate), at least for the first 10 years after surgery, at frequencies of 2 kHz and above. Total stapedectomy has given the worst results for hearing gain at frequencies above 2 kHz, and the rate of deterioration of gain over time seems to be more rapid than after small-fenestra techniques. Small fenestras are recommended as the preferred technique in all cases of surgically treatable otosclerosis.