The Learning Curve for Endoscopic Stapes Surgery

By June 7, 2019

Wick, Cameron C.1
1 Washington University School of Medicine, St. Louis, MO, USA.

Stapes surgery epitomizes the intricacies of otologic surgery. The expected good audiologic benefits are balanced against the unlikely, but potential, risk for vertigo and significant hearing loss. A classic report by Hughes in 1991 described a learning curve of 50 microscopic stapedectomies to achieve consistent good results. Those numbers are hard to come by in the current training paradigm.

Retrospective review of a single surgeon’s, prospectively maintained otologic database. Twenty-one consecutive cases were approached expecting to perform an endoscopic stapedotomy. Two cases were excluded for malleus fixation. 19 consecutive cases were reviewed, all reflecting the beginning of the surgeon’s career and his preference for an endoscopic stapedotomy approach using a CO2 laser and manual perforators for the stapedotomy. Outcomes for stapes surgery are reported.

The mean age was 55.9 years and 58% were on the left ear. Two cases required conversion to a stapedectomy technique. After a mean audiologic follow-up of 3.9 months, the postoperative pure-tone average (PTA) improved by a mean of 23.8 dB ­ 17 dB. 12 of 14 (85.7%) cases with audiologic follow-up achieved an air-bone gap (ABG) of less than 10 dB. The two oultiers were among the first four cases of the surgeon’s career and both achieved an ABG of less than 20 dB.

Endoscopic stapes surgery may have a reduced learning curve secondary to improved visualization. Additionally, the visualization of the footplate enables increased learning opportunities for residents and fellows.