LXXXIV Reparative Granuloma following Stapedectomy: A Clinical Entity

Abstract

The formation of reparative granuloma as one of the causes for sensorineural hearing loss as a complication of stapedectomy has been reported previously.6,13,17 The purpose of this paper is to present our experiences with this problem and to show that this condition can be diagnosed and treated with good results in many cases.The incidence of sensorineural loss from all causes following stapedectomy was reported in several studies 8 ,9 ,l1 to range from 0.6 per cent to 3 per cent. Harris and Weiss, on the other hand, found six granulomas which were confirmed by surgery, in 119 stapedectomies for a 5 per cent incidence.We found ten granulomas from a total of 780 recent stapedectomies for an incidence of 1.3 per cent. Three of these granulomas occurred following 170 fat-wire implants and seven occurred after 610 Gelfoam®-wire implants. All of these granulomas were grossly and microscopically confirmed.The evidence indicates that reparative granuloma is a major cause of sensorineural hearing loss following stapedectomy. During the period of this study there was only one additional case of sensorineural hearing loss in this series of 780 stapedectomies. Tympanotomy in this case disclosed that a perilymph fistula occurred after a Gelfoarn-wire implant. INITIAL SIGNS AND SYMPTOMSOf the ten cases of poststapedectomy granuloma, nine developed symptoms within the first six weeks (Table I). One patient experienced the onset of symptoms ten months following surgery.

Post-Stapedectomy Granuloma: A Rare Case Report

“…Accidental foreign bodies including cotton wool fibers, linen fibers from drapes, glove powder (talc or starch) [10] and fractured Teflon fragments have been considered to stimulate foreign body granuloma. However, Kaufman et al [6] and Buntner et al [5] found these materials to be non-contributory.…”

“…Presenting symptoms usually surface one to eight weeks following surgery and most commonly involve vertigo but may include sensorineural hearing loss, progressive mixed hearing loss, sudden hearing loss and tinnitus [3] [6]. Our patient presented with progressive mixed hearing loss, vertigo and otalgia.…”

“…There is disagreement regarding the mode of management of reparative granuloma. While Kaufman et al [6] advocate immediate surgical exploration and removal of granulation with replacement of prosthesis. Seicshnaydre et al [3] mentioned the use of high-dose steroids and antibiotics followed by delayed surgery.…”

Revision Stapes Surgery

“…(E) Hydroxyapetite bone cement can also be used to rebuild the shortened incus long process onto which the prosthesis can be secured but since they were taken off the market, this is an even rarer occurrence. Some are thought to be due to powder on gloves, but this has not been proven [29]. A recent report involved a granuloma after acellular porcine small intestinal submucosa was used to seal the piston at the oval window (Fig.…”

“…This is a rare condition that occurs usually 7–15th-day post-operatively after a stapedectomy [ 29 ]. It was highly associated in the past with manufactured gelfoam-wire prostheses, but since they were taken off the market, this is an even rarer occurrence.…”