STAPEDIUS TENDON RECONSTRUCTION

Jean-Bernard CAUSSE, M.D.

J.Causse Clinic

34440 COLOMBIERS Beziers (France)

The results of surgery for otosclerosis are particularly satisfactory even without reconstruction of the stapedius tendon. The stapedial reflex is more important for improving intelligibility of speech in the presence of background noise than for protection against hazardous levels of noise. An intact stapedial reflex improves ones ability to follow speech in the presence of background noise.

A joint exists between the posterior edge of the footplate of the stapes and the oval fossa. This joint has two walls. The wall of the footplate faces downward and backward and the wall of the oval fossa faces upward and forward.

Because of this arrangement, when the stapedius muscle contracts, the footplate is immediately fixed in the oval fossa. In two-thirds of the cases, the pyramidal process is lower than the attachment of the stapedius tendon onto the neck of the stapes. When a stapedotomy is performed and the fixed stapes has been replaced by a piston, the above described joint does not exist. if the stapedius tendon is kept intact, in two-thirds of the cases, when the stapedius muscle contracts, the piston is pushed into the vestibule more than fixed at the edge of the stapedotomy due to the interior position of the pyramidal process. In order to allow fixation of the piston and prevent penetration of the piston into the vestibule during the stapedial reflex, we reattach the stapedius tendon onto the shaft of the piston in a perpendicular orientation, using a Polycel platform. As the tendon itself will not attach to the Polycel platform, we leave a tiny space between the tip of the tendon and the platform and fill this space with loose perivenous connective tissue. This collagen-containing tissue acts like a natural glue.