Urgent revision stapedectomy for sudden hearing loss

Abstract

The polyethylene strut vein graft technique for oval window otosclerosis was initially enthusiastically advocated by many and utilized in large series. 1 ,2,3,4,5 Investigators were attracted by the strut's apparent nonreactivity and achievement of air-bone closure, with absence of early appreciable negative threshold shifts. Dr. Steffen, in 1963, presented 52 cases (of a series of 2,300 stapedectomies) in which polyethylene strut displacement became a significant factor in vestibular symptoms and auditory morbidity.G,7 Patients presented a wide variety of symptoms; the most ominous was sudden hearing loss. Exploration was performed when a malfunction of the stapes prosthesis was suspected.Fistula formation was present in approximately one-half the explored ears, and various amounts of strut slippage were found. Of the eight cases reported without measurable bone conduction responses pre-operatively, none improved post-revision, and in seven of the eight cases it was elected not to remove the displaced polyethylene strut. One cases is alluded to in which sudden hearing loss with subsequent strut replacement resulted in hearing return. It is interesting that, statistically, several days to weeks elapsed before revisions were performed.Our most recent experience emphasizes the urgency of early surgical exploration.CASE REPORT. Miss 1. M., age 49, underwent a right stapedeotomy for otosclerosis in 1961. Polyethylene vein graft technique was, used wi,th closure of the ailf-bone gap, and subsequently, she had three operative procedures on the left ear with resultant profound left sensori-neural hearing loss. The patient continued to complain of mild vertiginous attacks and mildly fluctuating hearing loss over the ensuing seven years. She was somewhat un.reliable as an informant, in that she was lost to follow-up for periods. of several months. When seen in October, 1968, for hearing aid evaluation, the following audiometric results were obtained (Fig.