Minimizing the dead ear in otosclerosis surgery

Objective Assessment of a specific surgical technique regarding the postoperative hearing results and the incidence of “dead ear” comparing local and general anesthesia. Methods We present a retrospective review of all stapedectomies performed by the same surgeon under general and local anesthesia during a 9-year period (1997–2006) in non-revision cases. The analysis of our data (268 operations, 160 under general and 108 under local anesthesia) included hearing results based on the guidelines from the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery and complications recorded in the case notes. Excessive vertigo during stapedectomy under local anesthesia considered as a sign of possible profound sensorineural hearing loss. Results A postoperative air-bone gap up to 10 dB (Grade A) was successfully obtained in 92.6% of operated ears. The mean postoperative air-bone gap in decibels was 6.8 dB. There were no statistically significant differences between general and local anesthesia in hearing results. Excessive intraoperative dizziness occurred in five patients of local anesthesia group without postoperative sensorineural hearing loss. The incidence of dead ear was 1.8 % (three patients) under general and 0% under local anesthesia. Conclusion Stapedectomy is a safe procedure in hands of an experienced otologist with minimum major complications especially when performed under local anesthesia. Local anesthesia offers the immediate evaluation of hearing restoration and the early recognition of possible dead ear. Training programs should consider stapedectomy under local anesthesia as a standard procedure for trainees in non-revision cases.