Preferences in Stapes Surgery Among American Otological Society Otologists

Objective: Stapes surgery is technically challenging, yet its methodology is not standardized. We aim to elucidate preferences in stapes surgery among American Otological Society (AOS) otologists and determine if any common practice patterns exist.

Study design: Cross-sectional study via emailed questionnaire.

Setting: Surgery centers.

Subjects and methods: Members of the AOS were an emailed a survey to quantify variables including surgical volume, anesthetic preference, laser use, type of procedure, footplate sealing technique, antibiotic use, and trainee participation.

Results: Most otologists (71%) performed 2 to 5 stapes surgeries per month under general anesthesia (69%) with stapedotomy (71%) as the preferred procedure. Most (56%) used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration. Either the handheld potassium titanyl phosphate (KTP) laser (40%) or handheld carbon dioxide (CO₂) laser (33%) was used. The heat-activated memory hook (51%) was the preferred prosthesis. Footplate sealing method was variable, as was antibiotic use among respondents. Trainee participation was limited, as 42% of otologists allowed residents to place the prosthesis, and fewer allowed residents to crimp the prosthesis, and laser or drill the footplate. Surgeons with higher surgical volume (≥ 6 surgeries per month) demonstrated the following statistically significant correlations: footplate fenestration with laser in a rosette pattern and pick for debris removal (r _s = -0.365, P = 0.014) and trainee participation with fellows only (r _s = 0.341, P = 0.022).

Conclusions: Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.

Keywords: Footplate; Laser; Otosclerosis; Resident training; Stapedectomy; Stapedotomy; Stapes surgery; Surgical preference; Surgical training.