Revision Stapes Surgery

Abstract

Purpose of Review This review briefly covers the history of stapedectomy, discusses the indications and problems encountered with revision surgery, and provides case examples with solutions. Recent Findings Revision surgery is challenging and successful outcome even in the most experienced specialists is 45–71%, which is far less than that of primary surgery. Summary Careful evaluation of the reasons for reoperation, anticipation of the common problems, and patient education on reasonable expectations are all very important for success.

Brazilian Society of Otology task force – Otosclerosis: evaluation and treatment

“… 247 , 248 , 249 , 250 Symptom onset may occur early, such as persistent hypoacusis, vertigo, or SNHL typically associated with intense tinnitus, or they may appear later in a sudden, fluctuating, or progressive manner, such as recurrent ABG. Except in cases of suspected perilymphatic fistula or granulation tissue, which according to some authors should be treated early, 251 an observational period of 6 weeks 252 to 3 months 253 is recommended. Because the outcomes of revision surgery in the literature are inferior to those of primary surgery, its indication should be carefully evaluated.…”

“…Because the outcomes of revision surgery in the literature are inferior to those of primary surgery, its indication should be carefully evaluated. 112 , 252 …”

“…Recent publications mention the indication of revision surgery for persistent or recurrent persistent ABG ≥ 20 dB and intractable vertigo, 112 but not for SNHL. 7 , 8 , 112 , 252 However, only a few studies investigated intractable vertigo as an indication for revision surgery; those that did found complaints of vertigo in 2%–3% of cases, mostly due to the prosthesis being too long. Patients responded well to replacement with an appropriately sized prosthesis.…”

“…Persistent ABG ≥ 20 dB may indicate incorrect technique in the primary surgery, lateral fixation of the malleus or incus to the attic, or the presence of a previously undetected third window, usually leading to worse results in revision surgery. 112 , 252 , 253 Recurrent or increasing ABG may indicate erosion of the long process of the incus, prosthesis displacement, inadequately sized prosthesis, scar adhesions, ossification of the fenestra, or granuloma. 247 , 251 , 253 In up to 82% of cases, there is necrosis of the long process of the incus and/or prosthesis displacement.…”

“…Adhesions and granulation tissue should be removed, and an appropriately sized prosthesis should be used. 252 , 253 Fat, vein, and blood grafts are used around the prosthesis to prevent the occurrence of fistula. 257 …”