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How to Avoid a Learning Curve in Stapedotomy

A Standardized Surgical Technique

Kwok, Pingling*; Gleich, Otto*; Dalles, Katharina*; Mayr, Elisabeth*; Jacob, Peter; Strutz, Jürgen*

doi: 10.1097/MAO.0000000000001475

Objective: To evaluate, whether a learning curve for beginners in stapedotomy can be avoided by using a prosthesis with thermal memory-shape attachment in combination with a standardized laser-assisted surgical technique.

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Fifty-eight ears were operated by three experienced surgeons and compared with a group of 12 cases operated by a beginner in stapedotomy.

Intervention: Stapedotomy.

Main Outcome Measures: Difference of pure-tone audiometry thresholds measured before and after surgery.

Results: The average postoperative gain for air conduction in the frequencies below 2 kHz was 20 to 25 dB and decreased for the higher frequencies. Using the Mann-Whitney-U test for comparing mean gain between experienced and inexperienced surgeons showed no significant difference (p = 0.281 at 4 kHz and p > 0.7 for the other frequencies). A Spearman rank correlation of the postoperative gain for air- and bone-conduction thresholds was obtained at each test frequency for the first 12 patients consecutively treated with a thermal memory-shape attachment prosthesis by two experienced and one inexperienced surgeon. This analysis does not support the hypothesis of a “learning effect” that should be associated with an improved outcome for successively treated patients.

Conclusion: It is possible to avoid a learning curve in stapes surgery by applying a thermal memory-shape prosthesis in a standardized laser-assisted surgical procedure.

*ENT-Department, University Regensburg, Germany

ENT-Department, Sørlandet Sykehus, Kristiansand, Norway

Address correspondence and reprint requests to Pingling Kwok, M.D., ENT-Department, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; E-mail:

Funding: No funding was received for this study.

The authors disclose no conflicts of interest.

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