Incus subluxation and luxation during stapedectomy

Area of Science:

• Otolaryngology
• Neurosurgery
• Audiology

Background:

• Stapedectomy is a common surgical treatment for otosclerosis, aiming to restore hearing.
• Complications during stapedectomy, such as incus luxation, can negatively impact hearing outcomes.
• Understanding the effects of incus subluxation is crucial for optimizing surgical results.

Purpose of the Study:

• To evaluate the hearing results in patients who experienced incus subluxation during stapedectomy.
• To assess the long-term hearing stability after managing incus subluxation.
• To determine the efficacy of repositioning the incus in cases of subluxation.

Main Methods:

• Retrospective analysis of 292 stapedectomy cases for otosclerosis.
• Identification of 15 patients (5%) with unintentional incus luxation during surgery.
• Surgical management involved repositioning the subluxated incus and prosthesis insertion, or malleovestibulopexy with autoincus in one complete dislocation case.

Main Results:

• Mean air-conduction threshold improved by 24 dB.
• Mean air-bone gap (ABG) significantly reduced from 34.6 dB preoperatively to 13.1 dB at 8 months post-surgery (p<0.0001).
• Hearing results remained stable at 10 years, with an average ABG of 10.6 dB.

Conclusions:

• Incus subluxation during stapedectomy, though a complication, can be effectively managed.
• Repositioning the incus allows for successful prosthesis insertion and good hearing gain.
• Stapedectomy with management of incus subluxation yields stable, long-term hearing improvements in otosclerosis patients.