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What is Fenestration?

John P. Leonetti, MD

April 16, 2007


Question

I have a patient who reports to me she had a "fenestrated" ear in the 1960s. I have tried to look up information on this topic with little success. I can find info that this was a surgery of this era that was used perhaps for middle ear complications and was replaced by the stapedectomy - but I am looking at what is involved in the surgery and what outcomes were expected. Just interested in the basics really - who were candidates, what was done, what was expected afterwards audiologically...etc.

Answer

Thank you for the question pertaining to the fenestration operation. I am a Surgeon Professor and the Vice-Chairman at Loyola University Chicago in the Dept. of Otolaryngology. I've been practicing for 20 years. As you know, otosclerosis is a disorder that results in conductive hearing loss due to progressive thickening of the stapes footplate. In the 1940s and 1950s surgeons performed the fenestration operation, which was successful in restoring some of the conductive hearing loss. In this procedure, a canal wall down mastoidectomy is performed. The lateral semi-circular canal is identified. A fenestration is made in the outer portion of the lateral semi-circular canal, preserving the end osteo layer. A fascia graft was then placed over this fenestration and the cavity was allowed to heal. In this way, when sound would enter the ear, it would bypass the thickened and fixed stapes footplate and would transmit through the lateral semi-circular canal, and eventually through the cochlea, in order to restore some of the conductive hearing deficit. At best, this operation brought the patients from a 70 or 80 dB conductive hearing loss to approximately 30 or 35 dB. Over time, in the 1960s, surgeons discovered that mobilization, and eventually removal of the stapes footplate, could restore normal or near-normal hearing, and the fenestration operation went to the wayside. There are still patients who have these mastoid cavities with fenestrations of the lateral semi-circular canal that require periodic mastoid cleaning. As a warning, manipulation with either an instrument or the suction near the fenestrated lateral canal can cause extreme vertigo and nausea, and therefore, cleaning of these mastoid cavities should be performed with great care. I hope this response will clarify your question pertaining to the fenestrated ear, and I thank you for the opportunity to provide this information.

John P. Leonetti, M.D. is a Surgeon, Professor, and the Vice-Chairman at Loyola University Chicago in the Dept. of Otolaryngology. He has been practicing for 20 years.


john p leonetti

John P. Leonetti, MD


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