Stapedotomy Removing Only the Stapes Head and Not the Entire Stapes Superstructure: Long-term Results.

OBJECTIVE: To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results. STUDY DESIGN: Prospective study. PATIENTS: The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical. RESULTS: No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant. CONCLUSION: The Malafronte's stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.

Partial Ossiculoplasty: Malafronte's Double Cartilage Block Versus Incus.

OBJECTIVES: To describe the outcomes of Malafronte's double cartilage block (mDCB) and incus autograft protheses, and to determine which prosthesis gives better and lasting hearing results. STUDY DESIGN: Prospective study. SETTING: ENT Department of AORN "S.G. Moscati" Avellino, Italy MATERIALS AND METHODS:: Partial columellar ossiculoplasties were performed on 102 patients. Malafronte's DCB was used on 58 patients (group 1). The reshaped autologous incus was used on 44 patients (group 2). The main follow-up for the whole study group was 4.5 years. MAIN OUTCOME MEASURES: Mean postoperative air-bone gap (ABG) closure to < 20 dB, incidences of prosthesis availability, prosthesis displacement from the tympanic membrane, and prothesis fixation to the middle ear walls. RESULTS: The hearing results and incidences of prosthesis availability, prosthesis slippage, and prosthesis fixation between groups 1 and 2 were significantly different. At the end of follow-up, a postoperative ABG of 20 dB or less occurred in 87.9% (n = 51) of patients in the group 1 and in 54.5% (n = 24) of patients in group 2. The Malafronte's DCB was always usable. While in 13.7% of cases, the incus was not usable. Prosthesis displacement and prothesis fixation were not observed in group 1. However, they were observed in 15 (34%) and 5 (11.3%) group 2 patients, respectively. CONCLUSION: The Malafronte's DCB gives more consistent hearing results. LEVEL OF EVIDENCE: 1b.