FENESTRATION OPERATION ANALYZED FOR NONFENESTRATING OTOLOGIST

THE NONFENESTRATING otologists are the supreme court judges of fenestration surgery. The fenestrating otologist knows that most otosclerotic patients with good bone conduction will obtain a gratifying restoration of hearing with the fenestration operation, that with microscopically perfect surgical technique the restored hearing will last in more than 95% of cases, and that the overwhelming majority of patients who have undergone fenestration are grateful patients. There are, however, many problems in which the nonfenestrating otologist has the great responsibility of advising his patient. To answer these problems from the selection of cases to the permanent hearing results is the goal of this presentation. The nonfenestrating otologists will always be in the overwhelming majority because of the relatively low incidence of fenestration surgery. A recent actuarial report on 100,000 operations from the leading group insurance companies,1 reports from the Michigan Medical Service,2 and a report from the Florida Blue Shield 3 (Table 1) indicate that there are several hundred tonsillectomies performed for every single fenestration. Totalling the figures discloses that there were almost 146,000 tonsillectomies performed, as compared with 114 fenestrations. With due appreciation for the variables in group insurance and the diminishing reserve of otosclerotic patients, there is an estimated maximum of 2,000 to 3,000 fenestration operations performed in the United States each year, or 10 to 20 fenestrations per 1,000,000 population a year. Equally divided, this number would be one fenestra¬ tion each 18 months for each of the 3,800 certified otolaryngologists in the United States. An analysis of 100,000 operations * discloses that the fenestration operation comprises about one-fourth of all ear operations and only five ten-thousandths of all surgical operations, while tonsillectomies comprise 17% of all operations. Actuarially, in the subspecialty of fenestration surgery, the otologist must draw from a population of 3,000,000 to perform the operation with enough frequency to perfect his surgical technique.