[Extreme stapedectomy].
Extreme stapedectomy is an operation aimed at restoring a serviceable hearing in patients affected by far-advanced otosclerosis with profound hearing loss. Surgery is performed on the understanding that the hearing aid will still be needed after the operation. Therefore, patient's expectations should be confined to possibly improved performance with a hearing aid as a consequence of the operation. Clinical as well as audiological preoperative assessment must be very rigorous. Counselling is mandatory and a trial period with a hearing aid is strongly advisable. Our experience is based on 15 cases, operated on between 1984 and 1988. A small fenestra technique was performed using wire-teflon piston prostheses. Results were satisfactory and in accordance with the ratio of the procedure in 8 cases (53%). 7 patients (47%) yielded an unsuccessful outcome and 2 of them had a dead ear (13%). This high rate of labyrinthine failure, the improvement in hearing aids and cochlear implants technologies well are likely to reduce the number of potential candidates for an extreme stapedectomy. However, this operation should be still kept in the otologist's armamentarium as a possible option in borderline cases.