title: Promontory drilling in stapedectomy.
abstract: OBJECTIVE
  Evaluate in stapedectomy the clinical outcome and audiometric results (particularly bone conduction) of drilling the promontory because of a narrow oval window niche.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Tertiary referral center, private otology practice.
  
  
  METHODS
  Twenty-five stapedectomy patients requiring promontory drilling who had surgery between 1995 and 2000.
  
  
  METHODS
  A total of 25 patients were evaluated with a minimum 6-month follow-up. Only patients who required promontory drilling and who had complete preoperative and postoperative audiometric testing including bone conduction were included. Promontory drilling was performed with a skeeter drill to thin the promontory. Twenty-five stapedectomy patients who did not undergo promontory drilling were randomly selected from this same period as a comparison group.
  
  
  RESULTS
  In addition to the narrow oval window niche, associated anatomical findings were facial nerve overhang in five patients and an obliterated footplate in three patients. Ninety-six percent of cases were successful (<10 dB postoperative air-bone gap). The one unsuccessful case was a strut over the mobile footplate that was later successfully revised. No patients suffered from intraoperative or postoperative tinnitus or vertigo. The mean 4-frequency (500-4,000 Hz) pure-tone average revealed slight improvement in bone conduction postoperatively.
  
  
  CONCLUSIONS
  Drilling of the promontory in stapedectomy is required in only a small percentage of cases. Although audiometric results indicated the possibility of a slight amount of acoustic trauma from the drilling, the effect on hearing was minimal and not considered a contraindication to this procedure.
authors.affiliation: The Lippy Group for Ear, Nose, and Throat, 3893 East Market Street, Warren, OH 44484, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Lippy
authors.forename: Leonard P
authors.initials: LP
authors.lastname: Berenholz
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Schuring
authors.forename: Franklin M
authors.initials: FM
authors.lastname: Rizer
authors.forename: John M
authors.initials: JM
authors.lastname: Burkey
mesh_terms: D000328:Adult; D000368:Aged; D001844:Bone Conduction; D004056:Differential Threshold; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000379:methods*