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

Abstract

Seventy-four revision stapedectomies performed consecutively over 10 years (1986 to 1995) were reviewed retrospectively. The most common intraoperative findings were incus erosion, prosthesis displacement, and oval window closure. Incus erosion was more frequently associated with multiple revisions. The postoperative results were reported using the conventional method (postoperative air minus preoperative bone) as well as the guidelines recently published by the American Academy of Otolaryngology--Head and Neck Surgery (postoperative air minus postoperative bone), with success rates of postoperative air-bone gap closure to within 10 dB after revision surgery of 51.6% and 45.6%, respectively. Patients with persistent conductive hearing loss (large residual air-bone gaps) after primary stapedectomy had poorer postrevision hearing results. Sensorineural hearing loss (defined as a drop in bone pure-tone average of more than 10 dB) occurred in four cases (5.4%). The number of revision surgeries, variations in operative techniques using laser or drill, and the ossicle to which the prosthesis was attached did not statistically affect the postoperative air-bone gaps. These results were compared with previously published data.

Cirurgia revisional de 74 casos de estapedectomia/estapedotomia

“…Os exames audiométricos 8,9,11,18 realizados no pré-operatório foram a audiometria tonal e vocal, a imitanciometria e o SRT, sendo esses exames repetidos no pós-operatório para sabermos da existência de ganho auditivo ou não 10,11 . Durante algumas revisões de estapedectomia usamos os diapasões em 512Hz e 1024Hz após o ato cirúrgico, para sabermos se a prótese estava no lugar, com conseqüente presença de boa audição do paciente.…”

“…A tomada audiométrica 8,9 é feita entre as diferenças de nível auditivo, nas vias aérea-óssea nos pré e pós-operatório nas freqüências de 500, 1000 e 2000Hz, que são as freqüências da palavra, vendo-se a quantificação da via óssea, que representa a reserva coclear 10,11 . Nessas revisões não usamos o laser [12][13][14][15][16] e mantivemos a técnica tradicional da cirurgia 1,2,[17][18][19][20] , com o emprego de ganchos especializados, usando raramente brocas afiadas para a abertura da base do estribo.…”

Epidemiologie der Otosklerose in den vergangenen 20 Jahren

“…1 Die generelle Abnahme der Stapedektomiefälle könnte allerdings auch dadurch bedingt sein, dass immer mehr Otologen Stapeschirurgie betreiben, so dass die Eingriffszahl pro Chirurg abnimmt. Schliesslich darf man nicht vergessen, dass das gewaltige Patientenreservoir in den letzten 40 Jahren progressiv operiert worden ist, so dass jetzt nur noch neue Fälle zur Behandlung kommen [20,[30][31][32].…”

Results after Revision Stapedectomy with Malleus Grip Prosthesis

“…1 The revision procedure usually involves the replacement of an incus-to-oval window prosthesis. However, if the long process of the incus is eroded or there is epitympanic fixation of the malleus or the incus, then the technique of malleus attachment stapedectomy can be used to establish a pathway for sound transmission from the tympanic membrane to the vestibule.…”

“…Reports published before 1997 were well summarized by Han et al 1 A review of these reports, as well as reports published after 1997, [8][9][10][11][12][13][14][15] indicates closure of the ABG to within 10 dB in 18% to 80% and to within 20 dB in 54% to 92% and a rate of sensorineural hearing loss of 0% to 20%. Thus, we conclude that the results of malleus attachment stapedectomy in our hands, as well as the results reported in the literature, are comparable to those after incus attachment in patients who undergo revision stapedectomy.…”