Failures in Stapedotomy for Otosclerosis

Abstract

OBJECTIVE: To review the results of 78 revision stapedotomies, determining the causes of failure and the predictors of surgical success. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Seventy-eight operations were performed in a tertiary referral center on 72 patients between 1995 and 2005. Indication for surgery was recurrent or persistent conductive hearing loss. RESULTS: The most common causes of failure were prosthesis displacement, incus necrosis, and oval window fibrosis. Postoperative air-bone gap was closed to within 10 dB in 54 percent of cases, and mean postoperative air-bone gap was 13.6 dB. Over-closure occurred in five percent of cases, sensorineural hearing loss in six percent of cases, and we had one postoperative dead ear. Success rates were higher in cases presenting prosthesis or ossicular malfunction than in cases with oval window problems. Hearing results did not differ if the prosthesis was crimped to either the malleus or the remnant of the long incudal process. Outcomes were similar for local or general anesthesia, and the nitinol piston did not significantly improve the hearing results. CONCLUSION: Revision stapedotomy is less successful than primary procedure. Lessening the surgical trauma provides the most favorable results.