Hearing Outcomes after Revision Stapedectomy Managed with Total Ossicular Prostheses

Area of Science:

• Otolaryngology
• Neurosurgery
• Audiology

Background:

• Stapedectomy is a common procedure for otosclerosis.
• Incus erosion can complicate stapedectomy, necessitating bypass procedures.
• Total ossicular prostheses (TOPs) offer a reconstructive option when the incus is absent.

Purpose of the Study:

• To describe the utilization of total ossicular prostheses (TOPs) in stapedectomy cases requiring an incus bypass.
• To evaluate the short- and long-term audiometric outcomes following TOP reconstruction after stapedectomy for incus erosion.

Main Methods:

• A case series with chart review was conducted at a tertiary neurotologic referral center.
• Seventeen patients undergoing revision stapedectomy with TOP reconstruction due to advanced incus erosion were analyzed.
• Pre- and postoperative audiometric data, including pure-tone averages (PTAs), air-bone gap, and speech discrimination scores, were assessed.

Main Results:

• The mean postoperative air-bone gap significantly decreased from 64.3 dB to 18.9 dB (P < .003) at an average follow-up of 22.2 months.
• No significant decrement in high-tone bone conduction PTA was observed (P = .427).
• One patient experienced a severe decrease in PTA and speech discrimination, indicating a risk of sensorineural hearing loss.

Conclusions:

• Total ossicular prostheses (TOPs) can provide favorable hearing outcomes in revision stapedectomy with limited incus reconstructive options.
• TOP reconstruction is associated with an elevated risk of sensorineural hearing loss.
• No further revisions were required in the observed follow-up period.