Superstructure-preserving stapes surgery in otosclerosis
Reviewed by Praneta Kulloo

Stapedectomy is a well-established procedure for otosclerosis but it has a small risk of a non-hearing ear, which can be devastating for patients. The development of a procedure which is safer and with a less steep learning curve for junior surgeons’ training is an attractive proposition. This team in Japan set out to share their experience of Takagi’s stapedotomy procedure in 24 otosclerosis patients. In this procedure, stapedotomy was performed without removal of the stapes superstructure, thereby reducing the risk of trauma to the stapes and inner ear. Instead, the lenticular process of incus was removed using a nipper and the piston prosthesis was attached to the long process of incus. The authors found that postoperative air-bone gap was ≤10dB in 66.7% of patients and ≤20dB in all cases at one-year follow-up. No patient developed sensorineural hearing loss. The main technical challenges they faced were inability to fenestrate the footplate without removing the superstructure in four patients and incus dislocation in two cases. With reported success rates of classic stapedectomy of about 70-95% to achieve air-bone gap ≤10dB, it is difficult to recommend Takagi’s stapedotomy procedure. Nevertheless, it is an interesting variation of conventional stapes surgery with some success. It also does make one wonder whether such a technique, with less surgical steps, can be used in a select group of patients with favourable middle ear anatomy to obtain equally good results as classic stapedectomy. Further larger studies would be needed to explore this as the current study, by the authors’ own admission, is fairly limited. Until then, classic stapedectomy remains the surgical treatment of choice for otosclerosis. 

Stapes surgery preserving the superstructure of stapes (Takagi’s stapedotomy) in otosclerosis: A retrospective study of 24 consecutive cases.
Sato S, Takagi A, Fujiwara T.
AURIS NASUS LARYNX
2018;45:1178-82.