Revision Stapes Surgery

Objectives. Surgery for otosclerosis has a highly satisfactory hearing outcome, for both the patient and the otologic surgeon. However, subsequent conductive hearing loss, dizziness/vertigo, or sound distortion could necessitate revision surgery. The aim of the present study is to evaluate the surgical findings and hearing outcomes of 84 revision stapes surgeries.

Study Design. Case series with chart review.

Setting. Tertiary referral center.

Subjects and Methods. At our institution, 84 revision cases were performed between 1998 and 2009. Conductive hearing loss was the revision indication in 69 cases, severe dizziness/vertigo in 8 patients, sound distortion in 5 cases, and progressive hearing loss with dizziness in 2 patients. Operative findings were noted in every case and evaluated separately.

Results. Surgical intervention revealed problems related to prosthesis in 51 cases, fibrotic bands in 26 cases, adhesions in 13 cases, incus necrosis in 15 cases, perilymphatic fistula in 3 cases, intact footplate in 5 cases, incus-malleus fixation in 2 cases, and reobliteration in 2 cases. Mean follow-up period was 19 months (range, 12-53 months). Successful hearing results (air-bone gap <10 dB) were reached in 58% of the cases, and satisfactory hearing results (air-bone gap <20 dB) were reached in 71% of the cases.

Conclusions. The ideal patient for revision stapes surgery is one who benefits from the initial surgery but complained of conductive hearing loss. In the present study, improvement in pure-tone average was 13.2 dB, and the mean air-bone gap was 9.6 dB.