Instructional Session: ISW10

Wednesday 4 July 2018, 16.45-17.45

What I have learned from carrying out 500 stapes operations over 25 years

Jack Lancer, Member of European Academy of Facial Plastic Surgery, Politzer Society, British Society of Rhinoplastic Surgeons, numerous medico-legal Associations etc.

Of all the surgery I have carried out over 25 years as an NHS Consultant the only operation where my technique has never changed is for stapes surgery, using the method learned from Professor Ugo Fisch. Most operations have been carried out under local anaesthesia (LA). In this presentation I will review the results of my surgery, and will discuss risks and complications both in general terms and for my own cases, in particular vertigo, tinnitus, taste disturbance, facial paralysis and loss and reduction in hearing levels, with special emphasis on the importance of consent, especially bearing in mind Montgomery v Lanarkshire Health Board. The technique of LA will be shown in detail. Surgery has invariably been carried out as a day case. I have recently published a survey of UK consultants who carry out stapes surgery and this will be discussed (recently published in European Archives of ORL).

My personal view is that stapes operations should be carried out only by specialist otologists, and while there are no specific guidelines in the UK, I would recommend that a minimum number of stapes operations to maintain competence is 12 per year. A straightforward stapes operation can be amongst the easiest operation for an ENT surgeon but a difficult stapes operation can be the most demanding of all ENT operations.

I hope these findings will go some way to educating budding otologists wishing to carry out stapes surgery. Surgeons should be encouraged to present a lifetime series of their specialist operation where possible.