James Brown

■ OBJECTIVES: The main objectives were; to review the hearing results in seven procedures over a three year post operative period in a large number of patients beginning in 1947 and ending in 2007, and  to pay tribute to the surgeons who developed these procedures. ■ METHODS: The study was retrospective since many audiograms including air conduction, bone conduction and speech discrimination were done and analyzed to determine the hearing results at 12, 24 and 36 months post operatively.

■ RESULTS: The first procedure was the Lempert fenestration done between 1947 and 1954; of the 231 cases the air-bone (A-B) gap was closed to 30DB in 210 cases (91%) after 2 years. The second was the Rosen Stapes Mobilization but the downside was that after one year only 50 (18%) of 276 cases closed the A-B gap to zero. The third was the Shea oval window fenestration with vein graft and PE prothesis in which 3068 (75%) of 4091 cases closed the air-bone gap to zero. This was my primary procedure from 1956 to 1962. The fourth procedure was the House stainless steel wire loop over gel foam. This was done from 1962 to 1990 and 4366 (83%) out of 5260 cases closed the A-B gap to zero. The fifth was the Teflon Piston attached to the long process of the incus. Of the 478 cases, only 47 (9%) closed- the A-B gap to zero. The sixth was a Teflon Wire Piston to the oval window fenestra resulting in 1658 (70%) out of 2339 cases closing the A-B gap to zero. The seventh and last procedure was the use of a thin stainless wire piston inserted into a small fenestra (6mm) in the center of the fixed stapes footplate. Of the 4502 patients, 4296 or (95%) closed the A-B gap to zero after 12 months.

■ CONCLUSIONS: The audience now should understand the historical evolution and changes in the diagnosis and surgical techniques made over the past sixty years, and now should be able to congratulate the surgeons and researchers who developed theseoperations leading up to the technique we have today.