Twenty-year review of revision stapedectomy

• Published in: Otology & neurotology Vol. 24; no. 4; pp. 560 - 566
• Main Authors: LIPPY, William H, BATTISTA, Robert A, BERENHOLZ, Leonard, SCHURING, Arnold G, BURKEY, John M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-07-2003
• Subjects: Animals; Biological and medical sciences; Equipment Design; Fenestration, Labyrinth - adverse effects; Finite Element Analysis; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Hearing; Humans; Medical sciences; Models, Theoretical; Ossicular Prosthesis - adverse effects; Reoperation; Retrospective Studies; Stapes Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the ear, the auditive nerve and the facial nerve; Human; ENT disease; Stapedectomy; Treatment; Review; Surgery
• ISSN: 1531-7129; 1537-4505
• DOI: 10.1097/00129492-200307000-00005

To evaluate surgical findings and techniques, patient management techniques, and audiometric results of 522 revision stapedectomies.
Retrospective chart review.
Tertiary otologic referral center.
A total of 522 revision stapedectomies over a 20-year period in Warren, Ohio, and Israel. The audiologic criterion for revision was an air-bone gap greater than 20 dB over the three-frequency range 0.5 to 2 kHz.
Of the 522 revision cases, a total of 483 patients were operated on to improve hearing. The remainder of the patients were operated on for various other noted reasons. Closure of the air-bone gap to within 10 dB was achieved in 71% of patients (343 of 483). The mean pure-tone average improvement was 17.8 dB, with an average postoperative air-bone gap of 7.3 dB. The most common surgical findings were prosthesis malfunction at the oval window, incus, or both (58%). Since beginning the use of the Argon laser for surgical problems, the success rate has increased to 80%. A subgroup of 35 Argon laser revision stapedectomies resulted in a larger hearing gain (25.2 dB) and 91.4% closure of the air-bone gap to less than 10 dB.
More than 70% of revision stapedectomy cases for hearing improvement have had successful closure of their air-bone gap. Since the introduction of the laser 5 years ago, the success rate has increased to 80%. In those specific cases where the laser was required, the success rate increased to 91.4%. Regardless of the revision technique, hearing results were the least successful when the incus could not be used for reconstruction.