The Learning Curve in Stapes Surgery and Its Implication for Training

Objective: To identify the ‘stapedotomy’ learning curve of 2 UK otolaryngologists. Study Design: A retrospective review of the outcome of the first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by UK otolaryngologists. Setting: Two tertiary referral centres. Patients: All ears in which primary stapedotomy was performed for otosclerosis. Non-otosclerotic cases and malleus stapedotomy cases were excluded. Intervention: One surgeon used the technique of small fenestra stapedotomy with either a Teflon™ wire or titanium piston, but without vein graft interposition, whilst the second employed the technique of stapedotomy with vein graft interposition, and a Teflon™ piston. Main Outcome Measures: The first 100 stapes operations performed by each surgeon were subdivided into consecutive groups of 10. Using a postoperative air-bone gap of 20 dB or better as a definition of ‘success’, the ‘success rates’ of each group were plotted on graphs - the learning curves. The end point of the learning curve was defined as the point ‘where the curve reaches its plateau’. Results: The learning curves of both surgeons included 70-80 operations. Both surgeons had one ‘dead ear’ in their first 15 cases. The postal survey showed that some trainers only perform a small number of stapes surgeries, whereas some otolaryngologists who regularly perform stapedotomies were not trainers. Conclusions: This is a mismatch of trainers and trainees in stapes surgery. If the current trend of decline in stapes surgery continues, it will take many years for some otolaryngologists to complete their learning curves.