Audiologic and Surgical Outcomes in Endoscopic Revision Stapes Surgery

By June 7, 2019

Nassiri, Ashley M. 1; Yawn, Robert J.1; Dedmon, Matthew M.1; Tolisano, Anthony M.2; Hunter, Jacob B.2; Isaacson, Brandon2; Rivas, Alejandro1
1 Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA;
2 Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

This study presents preliminary surgical and audiologic outcomes in endoscopic revision stapes surgery.

Patients: Six patients with a history of otosclerosis and prior stapes surgery with recurrent hearing loss.
Interventions: Totally endoscopic revision stapes surgery.

Main Outcome Measures: Surgical and audiologic outcomes.

Of the six patients in the study, 66.7% were female, and the average age was 53.2 years (range, 19-82 years). Patients had a median audiologic follow up of 7.4 months (range, 1.5-33.3 months). Intraoperatively, the chorda tympani nerve was preserved in four cases, while two had been previously transected. The most common surgical findings were displaced prosthesis (6/6) and incus necrosis (2/6). A laser was used to revise the stapes footplate fenestra in all cases. There were no intraoperative complications such as tympanic membrane tear, facial nerve injury, or floating footplate. The median air-bone gap (ABG) improved from 33 dB preoperatively to 15 dB postoperatively at last follow up (p=.03). The ABG was closed to within 20 dB in 67% of cases. There was one case of temporary postoperative SNHL and vertigo due to labyrinthitis that resolved with steroids.

This case series reports a median postoperative ABG of 15 dB following endoscopic revision stapes surgery. Improved visualization with the endoscope may prove advantageous in revision stapes surgery, however, a larger study is required to demonstrate efficacy.