Reducing patient risk and improving surgical outcomes whilst learning stapes surgery

Reducing patient risk and improving surgical outcomes whilst learning stapes surgery
Neil Bailie, Jerry Hallik

In the hands of experts, the results of stapes surgery are consistently good, with closure of the air-bone gap < 10 dB in 85% or better and dead ear rates of less than
1 %. The results when trainees perform the procedure are generally worse, with closure of the air-bone gap as low as 62 % and dead ear rates of up to 4 %. Traditionally, otologists have gained skill in stapedotomy during independent practice, with studies suggesting it takes 60 – 80 cases to become competent and with adverse hearing results reported in the early cases. An alternative learning model is to spend a period of intensive training with an expert otologist in a high volume practice. The surgical outcomes of such a training method were investigated, including the results achieved after transitioning to independent practice. During training, 90 stapedotomy procedures were performed in a 7-month period, with closure of the air-bone gap to less than 10 dB in 83 % and no adverse hearing outcomes. During independent practice, 52 stapedotomies were performed in a 4.5-year period. Air-bone gap was closure < 10 dB was achieved in 92 % with no adverse hearing outcomes. This new model is commended as method to acquire skill in stapes surgery.