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The Microscopic Transcanal Approach in Stapes Surgery Revisited
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Gusher in stapes surgery: a systematic review.

Matteo Alicandri-Ciufelli1, Giulia Molinari1, Maria Silvia Rosa2

  • 1Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|July 6, 2019
PubMed
Summary

Gusher, an unexpected complication during stapes surgery, is managed by sealing the oval window and tympanic cavity. Outcomes for hearing and vestibular function after this perilymphatic leak vary significantly.

Keywords:
GusherPerilymphatic leakStapes fixationStapes surgery

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Surgical Complications

Background:

  • Stapes surgery is a common procedure for hearing loss.
  • Gusher, or perilymphatic leak, is an infrequent but significant complication.
  • Understanding gusher management is crucial for otologic surgeons.

Purpose of the Study:

  • To systematically review the occurrence of gusher during stapes surgery.
  • To analyze the surgical management strategies for gusher.
  • To evaluate the post-operative outcomes related to hearing and vestibular function.

Main Methods:

  • Systematic literature review following PRISMA standards.
  • Inclusion of English, Italian, and French studies on stapes surgery mentioning gusher or perilymphatic leak.
  • Exclusion of studies lacking details on gusher management or hearing outcomes.

Main Results:

  • Twenty-four articles and 76 patients were included.
  • Gusher management primarily involved covering the oval window/tympanic cavity with grafts.
  • Hearing loss occurred in 25% of cases; 31% experienced worsening hearing. Outcomes varied, with 19% improved and 28% unchanged hearing.
  • Vestibular symptoms were mostly mild and transient when reported.

Conclusions:

  • Gusher is a relevant complication in stapes surgery requiring specific management.
  • Plugging the oval window and tympanic cavity are common interventions.
  • Hearing and vestibular outcomes following gusher are highly variable.