Incus subluxation and luxation during stapedectomy

Stapedectomy is a safe surgical procedure used in patients with otosclerosis. However, complications may occur and decrease hearing gain after the operation. The aim of the work was to analyze hearing results in patients with incus subluxation during stapedectomy. In 15 (5%) of 292 patients with otosclerosis, the incus was unintentionally luxated during surgery. In one patient the incus was completely dislocated and malleovestibulopexy with autoincus had to be applied. In 14 stapedectomies the incus was subluxated and though it was pathologically mobile it was held in position by its ligaments. This situation allowed delicate reposition of the incus and insertion of the piston prosthesis on the long incus process. Mean AC threshold improved by 24 dB. Mean ABG improved from 34.6+/-8.3 dB before to 13.1+/-6.3 dB 8 months after stapedectomy (t=9.7; p<0.0001). Ten years after surgery average ABG was 10.6+/-4.4, which means stable hearing result. In 6 patients including the individual with complete incus luxation, postoperative ABG was less than 10 dB. In 9 patients postoperative ABG was between 10 and 15 dB. When the incus is subluxated good hearing results can be expected after insertion of the prosthesis on the repositioned incus.