A retrospective comparative study between the use of micro-drill vs perforator in the fenestration of stapes footplate in the surgical treatment of otosclerosis

• Main Author: de Almeida, João Carvalho
• Publication Date: 2019
• Other Authors: Rego, Ângela Reis, Lino, João Vale, Gameiro dos Santos, José, Almeida e Sousa, Cecília
• Format: Article
• Language: por
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://doi.org/10.34631/sporl.731
• topic: Fenestration; Labyrinth; Stapes Surgery; Otosclerosis; Otosclerose; Estapedotomia; Fenestração

Objectives: To characterize the population of patients submitted to surgical treatment of otosclerosis, in the ENT Service at the Hospital Center do Porto, and retrospectively compare the use of microdrill vs perforator; To evaluate the hearing results, the duration of the surgery and the length of the hospitalization after the surgery, comparing the use of micro-drill with the one of perforator for fenestration of stapes footplate. Methods: All patients submitted to stapes surgery between January 2016 and December 2017 were retrospectively analyzed. A total of 49 patients, corresponding to 49 surgeries, were included in the study. The patients were divided into 2 groups, depending on the technique used for fenestration of stapes footplate - micro-drill or perforator. Results: The two groups were homogeneous with respect to the patient's baseline characteristics. Regarding the intraoperative parameters, the group of patients in whom the micro-drill for stapes footplate fenestration was used showed a decrease in operative time of about 11 minutes, although not statistically significant (p> 0.05). In addition, a difference was found between the two groups in terms of surgical success (closure of GAO values below or equal to 10 dB) with a higher success rate associated with the use of a micro-drill (86.7 % vs. 76.5%), although, once again, this difference was not statistically significant (p> 0.05). Regarding the variation of the bone conduction, in a global way, there was an improvement of this pathway with surgery. However, evaluating this variation independently for each frequency, it was verified that in patients where the micro-drill for stapes footplate fenestration was used, there was an average worsening of 0.71 dB in the bone conduction at the 4 kHz frequency, comparatively with patients who used the perforator who had an average improvement of 0.45 dB for the same frequency in the bone conduction, yet this difference was not statistically significant. Conclusions: In the study population, there were no statistically significant differences between the two stapes footplate fenestration techniques, although the use of a micro-drill was associated with a shorter duration of surgery and a higher rate of surgical success. However, the use of a micro-drill appears to be associated with a worsening of the bone conduction at the 4 Khz frequency, probably reflecting acoustic trauma. However, this difference was not statistically significant and this aggravation is incipient and not clinically relevant.