Otosclerose e a evolução da estapedotomia: uma revisão narrativa

Abstract

Otosclerosis is a progressive disease that affects the middle ear and otic capsule, characterized by the abnormal formation of bone tissue around the stapes, leading to conductive hearing loss and, in advanced cases, sensorineural hearing loss. This study aims to review the historical and technical evolution of stapedotomy, widely recognized as an effective treatment for otosclerosis. A total of 21 articles were analyzed, describing advancements in understanding the disease and innovations in surgical techniques. Historically, early approaches included conservative methods, such as pressure devices and tympanic massage, which had limited efficacy. In the late 19th century, surgical interventions emerged, such as stapes removal and fenestration techniques, which faced significant challenges due to severe complications and unsatisfactory outcomes. In 1952, Samuel Rosen introduced stapes mobilization, marking an important advance, albeit with temporary effects. The evolution culminated with John Shea’s development of stapedectomy in 1956, which replaced the stapes with a prosthesis. This technique marked a milestone in otologic surgery, providing long- lasting auditory improvements. Later, the technique evolved into stapedotomy, which involves creating a small perforation in the stapes footplate instead of its complete removal, reducing complications such as vertigo and inner ear damage. Simultaneously, prosthetic materials evolved from Teflon to titanium, promoting greater biocompatibility and stability. Cochlear implants emerged as an alternative for patients with advanced otosclerosis, particularly in cases of extensive cochlear calcification where stapedotomy is ineffective. These devices overcome anatomical limitations by directly stimulating the auditory nerve. Studies show that cochlear implants are effective in cases with severely impaired speech discrimination and severe calcification. This study highlights the importance of understanding the development of stapedotomy and associated technologies, valuing historical contributions and encouraging future innovations. The analysis of the evolution of surgical treatment for otosclerosis underscores how technical advancements have shaped current practices, offering safe and effective treatments.