Controversy : Stapedectomy through the postaural route?

"I have seen a few surgeons performing stapedectomy through the postaural route, it may be technically easy but is it the correct approach?standard contemporary literature does not mention this technique."

DR PRAVEEN KUMAR.ENT SURGEON KR HOSPITAL,MYSORE.
ASSISTANT PROFESSOR OF ENT,
MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE,
MYSORE,KARNATAKA,INDIA.

Please contribute your comment on link below or mail to update@entindia.net
Dr Neelam Vaid(Pune) said:
There are many ways to skin a cat.....i would guess if the surgeon is
comfortable with this approach so be it. More than wrong or correct,
better the surgeon does what he is comfortable with and gets good
results.

Dr M P Manoj said
Since the area of interest is posterosuperior quadrant a transcanal or endaural approach would be infinitely easier. However if some one can do it well any which way it should not be a cause for grave concern.

Dr Ajit Man Singh (Delhi)said:

Stapes is the smallest bone in the human body, and stapedectomy possibly one on the most precise surgeries, with the surgeon focussing and concentrating at 2 different focal lengths( the fooplate and the incus) at the same time with the two eyes. even in CI, one only needs to concentrate at only one level: the chochleostomy: at the time of insertion.

This said,
personal experience and training is important.
Ideally stapedectomy should be only through endomeatal route, as it gives adequate access with least soft tissue work/trauma.
Some surgeons are happy with a 9-12 incision, others ar more comfortable with a 6-12.
however, the ultimate goal is a good approach to the stapest footplate and incus., how one reaches it is immaterial. In UK I have worked with consultants who either use a small end aural incisiont hat a self retaining can be easily put and both hands become free, others prefer a post aural.
I dont think there is any shame in converting an endomeatal to a end-aural or post aural.

I dont think there is any controversy. as long as one has access with least morbidity. all approaches are: after all only approaches.

Dr Jankiram(Trichy)
. I AM AN ENT SURGEON FROM TRICHY.. IN FACT YOU CAN SEE A LOT OF STAPEDECTOMY VIDS ON YOUTUBE IN MY ID DrJanakiram123. I DO IT POSTAURALLY ONLY. REASONS ;;
WE ARE SO USED TO DOING MASTOIDECTOMIES POSTAURALLY..
SOME CASES NEED CANAL PLASTY BEFORE STAPEDECTOMY..
ITS NOT THE ROUTE BUT THE RESULT THATS IMPORTANT, MY RESULTS HAVE BEEN GUD WITH POST AURAL APP..
THIS GIVES EXCELOLENT EXPOSURE..
I DONT FIND ANY DISAD EXCEPT FOR THE SCAR WHICH MY PATIENTS DONT MIND..
I HAVE BEEN DOING IF FOR THE PAST 13 YEARS ..
THANKS FOR THE NICE POINT U HAVE BROUGHT OUT !!

Dr Deepak Dalmia, Mumbai
Sir, If an ENT surgeon is not able to perform stapedotomy by Endomeatal/ Miniendaural route, first he practice performing tympanoplasty by endaural route

DR NISHI SHARMA(Delhi)
Post aural approach is not the correct approach for stapedectomy as it does not give direct hesd on view of posterosuperior mesotympanum, endaural or permeatal approach are the approaches for tympanotomy.