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Stapedotomy (Endaural)

David M. Kaylie, MD, MS; C. Scott Brown, MD
Duke University Medical Center

Dr. David Kaylie demonstrates the endaural approach to the middle ear in order to perform a stapedotomy for conductive hearing loss secondary to otosclerosis. This technique can be utilized for other middle ear conditions, including attic cholesteatomas.


The endaural approach to the middle ear, particularly for stapes surgery, carries distinct advantages compared to a typical transcanal exposure. By extending the incision laterally and between the incisura (space between tragal and helical cartilage), the surgeon is afforded with additional exposure to the epitympanum. In the event of malleus fixation (i.e. mobile stapes), the surgeon will then have access to perform an atticotomy and expose the proximal ossicular chain if necessary. By using a self-retaining retractor, the surgeon can work without the confines of a speculum. The external incision is typically well-hidden and does not contribute significantly to cosmetic concerns. Particular care must be taken to ensure that the edges of skin that are elevated during surgery are returned to a flat, unfurled position to prevent the development of canal cholesteatomas.


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