The patient was was a 24 year old male presented with bilateral conductive hearing loss of about 50 dB. Clinical diagnosis of Otosclerosis was made. In the left ear exploration revealed a mucosal band vertically connecting the sides of the oval window, which was extremely narrowed in this region. The region could not admit even a 0.4 mm piston prosthesis and the footplate could not be perforated with the author’s stapedectomy instruments. A Skeeter drill was needed to safely perforate and remove the surrounding bone. Surgery was abandoned to due unavailability of the proper instruments. The patient was referred to an otologist in Pune, India (Dr. Kailash Sant) who had the necessary equipment and he completed the procedure. Post operatively the patient was fitted with 0.4*4.5 mm Teflon prosthesis and his post-op hearing improved to 20 dB. In this situation, two techniques may be utilized.
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Removal of the existing footplate and placement of a tissue graft and placement of a 0.4mm prosthesis or a House Wire.
A Skeeter Drill can be used to thin and remove bone next to the inferior portion of the footplate and then the surgeon's standard technique can be used. Drilling superiorly must be done with extreme care because of the facial nerve.
Abstract: A case report and video showing a patient with restricted access to the oval window and stapes footplate along with a discussion of management alternatives.
Author: Jayant K. Watve, Professor and Head, Dept of E.N.T. Rajarshi Chhatrapati Shahu Maharaj Govt. Medical College (RCSMGMC) Kolhapur, India.