Revision Stapes Surgery: Hearing Symptoms and Associations With Intraoperative Findings and Outcomes

Otolaryngol Head Neck Surg. 2022 Aug;167(2):350-355. doi: 10.1177/01945998211062074. Epub 2021 Nov 30.

Abstract

Objective: Stapes surgery for otosclerosis occasionally requires revision due to recurrent or persistent conductive hearing loss (CHL). This study examines outcomes after revision stapes surgery.

Study design: Retrospective review.

Setting: Single tertiary neurotology center.

Methods: Patients undergoing revision stapes surgery for otosclerosis from 2008 to 2017 were reviewed. Postoperative air-bone gaps (ABGs) were the primary outcome measure.

Results: During the study period, 150 patients underwent revision stapes surgery. One hundred patients (67%) had gradually progressive recurrent CHL; 16 (11%), sudden recurrent CHL; 13 (9%), persistent CHL; and 21 (14%), no CHL. For 129 patients with CHL, the mean ABG improved from 23.7 to 9.3 dB (P < .0005). The most common intraoperative findings for these patients were prosthesis displacement with incus necrosis (38%) or without it (43%), normal anatomy with seemingly good prosthesis placement (6%), and abundant scar tissue (6%). Patients with recurrent hearing loss achieved lower mean ABGs than patients with persistent hearing loss (8.8 vs 13.2 dB, P = .02). There were no associations between onset pattern of CHL or intraoperative findings and hearing outcomes (P > .05). Four patients (2.7%) developed sensorineural hearing loss after revision, defined as an increase in bone conduction pure tone average ≥15 dB, all of whom had previous replacement of a malpositioned prosthesis.

Conclusions: Revision stapes surgery confers significant improvement in hearing for patients with persistent and recurrent CHL, although patients with persistent CHL after initial surgery see less improvement with revision.

Keywords: air-bone gap; hearing loss; otosclerosis; revision; stapes surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Hearing
  • Hearing Loss* / complications
  • Hearing Loss, Conductive / etiology
  • Hearing Loss, Conductive / surgery
  • Humans
  • Incus / surgery
  • Otosclerosis* / complications
  • Otosclerosis* / surgery
  • Reoperation
  • Retrospective Studies
  • Stapes
  • Stapes Surgery*
  • Treatment Outcome