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