The learning curve in stapes surgery and its implication to training.
OBJECTIVE
To identify the stapedotomy learning curve of two U.K. otolaryngologists.


METHODS
A retrospective review of the outcome of first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by U.K. otolaryngologists.


METHODS
Two tertiary referral centers.


METHODS
All ears in which primary stapedotomy was performed for otosclerosis. Nonotosclerotic cases and malleus stapedotomy cases were excluded.


METHODS
One surgeon used the technique of small fenestra stapedotomy with either a Teflon-wire or titanium piston but without vein graft interposition, whereas the second used the technique of stapedotomy with vein graft interposition and a Teflon piston.


METHODS
A moving average with a window of 15 dB was used to plot learning curves for the postoperative air-bone gaps. Using a postoperative air-bone gap of 20 dB or better as a definition of 'success,' the success rates with the increase in surgical experience of both surgeons were plotted on graphs, the learning curves. The end point of the learning curve was defined as the point where the curve reached its peak, and the results were sustainable.


RESULTS
There was no clear-cut end point in both learning curves, although it appears that there is a landmark point at 60 to 80 cases for both surgeons. Both surgeons also had one "dead ear" in their first 15 cases. The postal survey showed that some trainers only performed small numbers of stapes surgery, whereas some otolaryngologists who performed stapedotomies regularly were not trainers.


CONCLUSIONS
The study supports a learning curve in stapes surgery. To maximize the training opportunity of trainee surgeons, it may be advisable for learning centers to form network to provide target training for the trainee who has demonstrated the necessary dexterity and temperament of an otologist.
Department of Otolaryngology, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK. matthewyung@btconnect.com
M W
MW
Yung
J
J
Oates
S L
SL
Vowler
D000328:Adult; D001301:Audiometry, Pure-Tone; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000175:diagnosis / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013201:Stapes Surgery / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom