Primary Endoscopic Stapes Surgery: Audiologic and Surgical Outcomes

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 reports audiologic and surgical outcomes from the largest endoscopic stapes surgery experience to date.

Study Design: Retrospective case series
Setting: Two tertiary otologic centers
Patients: Eighty-one ears with surgically confirmed stapes fixation
Interventions: Total endoscopic stapedotomy or stapedectomy

Main outcome measures: Surgical and audiologic outcomes.

Eighty-one subjects were included (60% female) with a median age of 47.6 years (range, 19.1-73.6 years). Etiologies of hearing loss included otosclerosis (96.3%), stapedial ankylosis (2.5%), and congenital stapes fixation (1.2%). The median follow-up was 5.3 months (range, 1.2-50.4 months). 74.1% required scutum removal, and the chorda tympani nerve was sacrificed in 7.4%. Two techniques were utilized: 51.9% underwent stapedectomy and 48.1% underwent stapedotomy (with use of laser, drill or both in 74.4%, 20.5% and 5.1% of cases, respectively). The median air-bone gap (ABG) improved from 31.3 dB preoperatively to 6.25 dB postoperatively at last follow-up (p<0.0001). The ABG closed to <15 dB in 96.3% of patients and <10 dB in 84%. There were no instances of postoperative sensorineural hearing loss (defined as >15 dB change from baseline) or facial nerve injury. Postoperatively, 29.6% of patients reported dysgeusia, of which 8.3% was persistent at last follow-up. Postoperative disequilibrium was reported in 17.3% of cases, with 100% resolution at last follow-up. Comparison of the stapedotomy and stapedectomy groups revealed no significant differences in audiologic or surgical outcomes.

Endoscopic stapedotomy and stapedectomy are effective techniques to manage stapes fixation resulting in a median postoperative ABG of 6.25 dB and ABG closure to within 10 dB in 84% of patients.