Outcomes After Tympanic Membrane Perforation During Primary Stapes Surgery for Otosclerosis

Area of Science:

• Otolaryngology
• Otologic Surgery
• Audiology

Background:

• Intraoperative tympanic membrane perforation (ITMP) during stapes surgery traditionally leads to procedure abortion due to infection and sensorineural hearing loss (SNHL) concerns.
• This study investigates the outcomes of primary stapes surgeries completed despite ITMP.

Purpose of the Study:

• To examine the hearing outcomes and complication rates in primary stapes surgeries performed with and without intraoperative tympanic membrane perforations (ITMP).
• To determine the safety and appropriateness of completing stapes surgery concurrently with tympanoplasty when a small ITMP occurs.

Main Methods:

• Retrospective review of patients diagnosed with otosclerosis between February 2008 and September 2017.
• Analysis of post-operative air-bone gap (ABG), pure tone averages, and complications in 652 primary stapes operations, comparing cases with and without ITMP.

Main Results:

• No significant differences in pre-operative hearing or demographics were found between groups.
• Post-operative ABG and change in ABG were similar between ears with and without ITMP.
• Patients with ITMP reported more post-operative dysgeusia but had similar rates of reparative granuloma, otitis media, or SNHL compared to controls.

Conclusions:

• This study presents the first review of ITMP and hearing outcomes after stapes surgery.
• Findings suggest that proceeding with primary stapes surgery and concurrent tympanoplasty in the presence of a small ITMP is likely safe.
• Minimal risk of infection, SNHL, or worsened hearing outcomes is associated with completing the procedure.