Stapedectomy in patients with a prolapsed facial nerve

We evaluated the method of stapedectomy and hearing results in patients who have 50% or more of the footplate covered by a prolapsed facial nerve.

We conducted a retrospective review of 1497 primary stapedectomies performed between 1986 and 1995.

Twenty-eight patients had 50% or more of the oval window covered by a prolapsed facial nerve. Twenty-three patients in this group had adequate follow-up and their hearing results were compared with a matched control group of 50 patients with normal facial nerve anatomy. Also, facial nerve outcomes and any other complications are reported.

In the patient group with facial nerve prolapse, closure of the postoperative air-bone gap to 10 dB or less was achieved in 19 of 23 (83%) ears and 16 of 20 (80%) ears at 6 months and 1 year, respectively. At 6 months and 1 year, the postoperative air-bone gap in 47 of 50 (94%) ears and 40 of 43 (93%) ears in the control group had closed to 10 dB or less. The average postoperative air-bone gap was 5.1 dB at 6 months and 6.8 dB at 1 year for the group with facial nerve prolapse. In comparison, the average postoperative air-bone gap in the control group was 3.5 dB and 3.9 dB, respectively. The difference in the hearing results for the 2 groups was not statistically significant.

When the facial nerve covered at least 50% of the oval window, the poststapedectomy hearing results at 6 months and 1 year were similar to those of a matched control group of stapedectomy patients with a normal facial nerve course. There were no short- or long-term facial nerve complications in either group. In light of these results, we conclude that stapedectomy in patients with significant facial nerve prolapse can be performed safely with good hearing results.