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Updated: Jun 18, 2026
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The Microscopic Transcanal Approach in Stapes Surgery Revisited
Published on: February 16, 2022
Revision stapes surgery: the "lateralized piston syndrome"
Sebastien Lagleyre1, Marie-Noelle Calmels, Bernard Escude
1Department of OtologyYNeurotology and Skull Base Surgery, Purpan University Hospital, Toulouse, France. lagleyre.s@chu-toulouse.fr
Summary
Lateralized piston syndrome, a cause of hearing loss after stapes surgery, occurred in 18.5% of revisions. Surgical correction effectively restored hearing, with offset pistons showing superior results for eroded incus cases.
Area of Science:
- Otolaryngology
- Neurosurgery
- Surgical Innovation
Background:
- Revision stapes surgery is necessary for various reasons.
- Lateralized piston syndrome is a specific cause of hearing loss following stapes surgery.
- This syndrome involves piston displacement after stapedotomy.
Purpose of the Study:
- To define diagnostic criteria for lateralized piston syndrome.
- To outline effective surgical management strategies for this condition.
- To evaluate outcomes of revision stapes surgery for lateralized piston syndrome.
Main Methods:
- Retrospective study over 13 years at a tertiary referral center.
- Analysis of 1,289 stapes operations, identifying 22 cases (18.5%) of lateralized piston syndrome.
- Review of medical records, audiograms, CT scans, and operative reports.
Main Results:
- Delayed conductive hearing loss was present in 95.5% of cases.
- Preoperative CT scans revealed piston lateralization in 81% and contact with the tympanic membrane in 54.5%.
- Revision surgery showed piston displacement in 86%, stapedotomy closure in all cases, and incus necrosis in 77%.
Conclusions:
- Lateralized piston syndrome accounts for 18.5% of stapes surgery revisions.
- Surgical intervention effectively corrects conductive hearing loss.
- Offset pistons yielded better outcomes than total ossicular replacement prostheses (TORPs) in cases with significant incus erosion.
