Results after Revision Stapedectomy with Malleus Grip Prosthesis

Abstract

Revision stapedectomy with a malleus grip prosthesis is a technically challenging otologic procedure. The prosthesis is usually longer and extends deeper into the vestibule than a conventional stapes prosthesis, creating the potential to affect the vestibular sense organs. The prosthesis also bypasses the ossicular joints, which are thought to play a role in protecting the inner ear from large changes in static pressure within the middle ear. The prosthesis is in close proximity to the tympanic membrane, thus increasing the risk for its extrusion. We reviewed our experience with revision stapedectomy with the Schuknecht Teflon-wire malleus grip prosthesis in 36 ears with a mean followup of 23 months. The air-bone gap was closed to within 10 dB in 16 ears (44%) and to within 20 dB in 26 ears (72%). The incidence of postoperative sensorineural hearing loss was 8% (3 ears). There were no dead ears. Extrusion of the prosthesis occurred in 1 case (3%). Nearly 50% of patients reported various degrees of vertigo or disequilibrium during the first 3 weeks after surgery. These vestibular symptoms resolved by 6 weeks in all but 1 case. We did not find evidence of damage to the inner ear due to the length of the prosthesis or due to the potential for direct transmission of changes in static pressures within the middle ear to the labyrinth. Our results are similar to those published in the literature for malleus attachment stapedectomy and conventional revision incus stapedectomy.

Morphology of the Malleus Handle and the Comparison of Different Prostheses for Malleostapedotomy

“…The tympanic membrane was detached from the complete malleus handle, the wire wrapped around the malleus handle and the Teflon piston inserted in the stapedectomy opening. The operation was technically difficult because of the limited exposure of the transcanal approach; the results were considered unsatisfactory (4) and carried a high risk (8.5%) for inner ear hearing loss (3,5).…”

Malleostapedotomy Revisited

“…3, A); the PTA showed an ABG of 45 dB (Fig. Previous researchers have pointed out that the prosthesis in handle-MS is in close proximity to the TM, placing the prosthesis at some risk of extrusion (9). 3, C).…”

The Use of Cartilage in Revision Stapedectomy

“…The main difference between these papers and ours is that our discussion focuses on cases where extrusion occurred, rendering a compromised tympanic membrane. In the Sarac et al (9) review, there were 36 ears studied using a malleus grip prosthesis, but none of the patients had chronic otitis media. The mean postoperative ABG was 14 dB, larger than our postsurgical ABG, but their follow-up was longer.…”