Mobilization of the Perilymph: Assessment of Techniques

THE PURPOSE of this paper is to clarify, simplify, and bring scientific order to the nomenclature used to describe the many different techniques of stapes surgery for otosclerotic deafness. There are now more than 25 techniques, all different in approach and yet all capable of restoring normal or near-normal hearing. The physiology and pathophysiology involved in stapes surgery are most often spoken of in terms limited to a description of a technique without sufficiently explaining and evaluating its effect. Individual surgical methods are evanescent, changing, and, as we know, not final. However, there are relationships of all these variable techniques to a structure which remains constant at all times. This structure is the perilymph. A successful surgical result depends inevitably upon the mobilization of the perilymph. None of the stapes operations can restore hearing until the cochlear fluids are set in motion. Under normal conditions the drum and ossicular chain