Revision stapes surgery – aspects of indication and surgical strategies based on 114 surgical cases

 

Introduction Primary stapes surgery with stapedotomy or stapedectomy already belongs to the most challenging interventions in ear surgery. In spite of an acute risk of deafness in 0.5-1 percent of all primary interventions, as described in the literature, this procedure has still a good benefit-risk ratio due to the improvement in hearing and quality of life that is usually achieved. Revision interventions are very heterogeneous procedures, both in terms of the indication and the surgical approach, and are generally considered to be significantly more demanding.

Methods Using the university hospital surgery database, 114 revision cases were identified between 2011 and 2022. Every procedure was analyzed based on biographic data as well as clinical, audiological, and intraoperative findings as well as the eventual therapy. Afterwards, the revision cases were analyzed regarding indication and the surgical approach chosen.

Results Based on the indication, acute, subacute and long-term complications of the primary intervention (“prosthesis-related” vs “procedure-related”) progressive as well as other incidental otological diseases such as progressive hearing loss can be identified as reasons for revision surgery. Preoperative clinical findings were correlated to intraoperative findings and surgical approaches. Audiological results are discussed.

Conclusions Depending on the individual preoperative case history and findings, different recommendations for the indication of a surgical revision can be derived. In addition, there are patterns regarding the chances of success of a revision, especially in cases of persistent conductive hearing loss chances of hearing improvement seem possible in more than 80% of cases.

Publication History

Article published online:
12 May 2023

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