Promontory drilling in stapedectomy.
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.
Lippy
William H
WH
The Lippy Group for Ear, Nose, and Throat, 3893 East Market Street, Warren, OH 44484, USA.
Berenholz
Leonard P
LP
Schuring
Arnold G
AG
Rizer
Franklin M
FM
Burkey
John M
JM
D000328:Adult; D000368:Aged; D001844:Bone Conduction; D004056:Differential Threshold; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000379:methods*