Stapedotomy versus stapedectomy: an ancient match considered from another point of view

Purpose: Analysis of the differences in inner ear admittance achieved by a large fenestra in comparison with a small fenestra and its effect on bone conduction in stapes surgery. Materials and methods: Description of an interesting case of bilateral otosclerosis with an atypical and symmetrical behaviour of bone conduction, treated with a stapedotomy on the right ear some years before, and recently submitted to stapedectomy on the left year. Results: Concerning the left side, the first complete audiometry was made 15 days after stapedectomy and confirmed a bone conduction improvement, that subsequently increased until almost to the normality 42 days after surgery. The mean postoperative bone conduction difference was 13 dB considering all frequencies; when considering the frequencies between 500 and 2000 Hz the mean difference raised to 20 dB. Conclusions: The reported case, in which the stapedectomy was not scheduled as the first option, but derived from a particular intraoperative situation thus resulting in an almost obligatory choice, permits some interesting conceptual considerations.