Results of revision stapedectomy for conductive hearing loss

Abstract

Revision stapedectomy operations performed over a 13-year period (1977 to 1990) for a conductive hearing loss are reviewed in terms of intraoperative findings and hearing results. All operations were performed in a conventional manner without use of laser techniques. A management algorithm based on intraoperative findings is described. Results are compared with previously reported series. The 66 cases include 20 males and 46 females, ranging in age from 8 to 73 years. Mean time between original and revision stapedectomy was 12.5 years. Prostheses encountered at time of revision included wireloop (29), Robinson (18), polyethylene (14), other (3), and two were not found. The most common cause of failure was displacement of the prosthesis. Incus erosion was found in 48% of wireloops, 35% of polyethylene, and only 11% of the Robinson prostheses. Revision resulted in closure of the pure-tone average (PTA) air-bone gap to within 10 dB in 46% and to within 15 dB in 76%. Sensorineural hearing loss (> 10 dB) occurred in 5 cases (7.6%), and a decline in speech discrimination (> 10%) occurred in 17%. Three of four cases requiring drillout had gap closure to within 10 dB. Findings suggest that our management technique produces results comparable to other large reported series. Drillout at the time of revision can be recommended.

Revision Stapedectomy: Intraoperative Findings, Results, and Review of the Literature

“…In previously reported series, successful revision surgery was often defined as closure of the air‐bone gap to within 10 dB. This was achieved in 18% to 80% of the cases reported by various authors 1‐20 . The postoperative hearing was considered to be significantly improved when the air‐bone gap is closed to within 20 dB.…”

“…Sensorineural hearing loss due to inner ear trauma is more likely to occur during revision surgery. In experienced hands, successful results (postoperative air‐bone gap closure to within 10 dB) have been reported in 18% to 80% of cases, with a mean of approximately 50% in most series 1‐20 . In the same series, the postoperative sensorineural hearing loss (a drop in bone conduction threshold more than 10 dB) was found in the range of 0% to 20% of cases.…”

Die Arrosion und Nekrose des langen Amboßschenkels nach Otoskleroseoperation

“…Die Amboßarrosion wurde nach Prothesen differenziert angegeben mit 35% (Polyethylenröhrchen), 48% (BDP) und 11% (Robinson-Prothese) [24]. Sie lassen jedoch keine Rückschlüsse zu, ob die Amboßschenkelzerstörung alleiniger pathologischer Befund, Zweit-bzw.…”

“…Revisionen Als Grund für die teilweise oder vollständige Zerstörung des langen Amboßschenkels wurde die Störung der Blutversorgung ("avascular necrosis") angesehen [24], weiterhin wurden Tubenbelüftungsstörungen oder "Mittelohrprobleme in der Kindheit" vermutet [7].…”

Stapes Surgery: How Precisely Do Different Prostheses Attach to the Long Process of the Incus with Different Instruments and Different Surgeons?

“…Excessive scar formation or a regrowth of otosclerosis in the footplate area has been discussed as a further reason for erosion of the incus (5). The long process of the incus can move against a medially fixed prosthesis, causing an initial notching and finally necrosis of the long process of the incus (6).…”