Total Endoscopic Fisch’s Reversal Step Stapedotomy

By June 7, 2019

Campos M., Ángela M.1; Otoya T, Ana M.2
1 Division of Otology & Neurotology, Department of Otolaryngology, Hospital Infantil Universitario de San José, Bogotá, Colombia;
2 Fellowship on Otology & Neurotology, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia.

Classic stapedotomy consists of removing the stapes suprastructure, followed by footplate perforation and prosthesis insertion. However, footplate incidents such as floating or fracturing the footplate can occur (1). To prevent these situations, Fisch described a complete reversal of surgical steps (2), based on the fact that the stapes fixes the footplate and thus allows a controlled footplate perforation. Nevertheless, few endoscopic ear surgeons use this technique (3-6). We present a video that describes the technique of endoscopic Fisch’s reversal step stapedotomy.

Nine patients with otosclerosis underwent endoscopic Fisch’s reversal step stapedotomy between February 2017 and August 2018, with no exposure and instrumentation difficulties. A didactic video describing the step-by-step surgical technique is presented.

  1. External auditory canal infiltration with 1% lidocaine and 1/200,000 epinephrine.
  2. Tympanomeatal flap elevation, preserving corda tympani.
  3. Minimal curettage of the scutum, visualizing the pyramidal eminence, incudostapedial joint, facial nerve, stapes and footplate.
  4. Confirmation of stapes fixation.
  5. Prosthesis size measurement.
  6. Footplate perforation, insertion and fixation of the prosthesis.
  7. Stapedial tendon cutting, incudostapedial joint dislocation and removal of the stapes suprastructure.
  8. Tympanomeatal flap repositioning and support with minimal gelfoam.

Fisch’s reversal step stapedotomy starts with the footplate perforation and insertion of the prosthesis, followed by removing the stapes suprastructure, preventing footplate incidents. Almost all endoscopic ear surgeons use the classic stapedotomy technique. However, we show total endoscopic Fisch’s reversal step stapedotomy is feasible.

Total endoscopic Fisch’s reversal step stapedotomy is feasible. No exposure and instrumentation difficulties impeded this procedure to be completed.