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Published on: January 19, 2022
Outcomes After Tympanic Membrane Perforation During Primary Stapes Surgery for Otosclerosis
Alexander L Luryi1, Amy Schettino2, Elias M Michaelides3
1Department of Neurotology, Michigan Ear Institute, Farmington Hills, MI, U.S.A.
Objective/Hypothesis:
Stapes surgery is occasionally complicated by an intraoperative tympanic membrane perforation (ITMP), traditionally indicating abortion of the procedure due to concerns for postoperative infection and sensorineural hearing loss (SNHL). This work examines outcomes and complications in completed primary stapes surgeries with and without ITMP.
Study Design:
Retrospective review.
Methods:
All patients diagnosed with otosclerosis between February 2008 and September 2017 at a tertiary otology referral center were reviewed retrospectively. Primary outcome measures were post-operative air-bone gap (ABG), air conduction and bone conduction pure tone averages, and post-operative complications.
Results:
Review revealed 652 primary stapes operations meeting inclusion criteria, of which ITMP occurred in 10. There were no significant differences in pre-operative hearing metrics or demographic characteristics between ears with and without ITMP. There were also no significant differences in post-operative ABG (6.4 vs. 8.0 dB HL, P = .43) or change in ABG after surgery (-21.6 vs. -18.2 dB, P = .34) between these two groups. Patients with ITMP were more likely to complain of post-operative dysgeusia (30.0% vs. 5.3%, P = .015) but were no more likely to develop reparative granuloma, otitis media, or SNHL (P > .05).
Conclusions:
The first review of ITMP and hearing outcomes after stapes surgery is presented. Our findings suggest that it is likely safe and appropriate to proceed with primary stapes surgery and concurrent tympanoplasty in the presence of a small ITMP with minimal risk of infection, SNHL, or worsened hearing outcomes.
Level Of Evidence:
4 Laryngoscope, 131:E2026-E2030, 2021.
Insights
Intraoperative tympanic membrane perforations (ITMP) during stapes surgery do not significantly impact hearing outcomes. Proceeding with stapes surgery and tympanoplasty in cases of small ITMP is safe, with minimal risk of complications like sensorineural hearing loss.
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.
