Endoscopic Stapedectomy: Does Oval Window Packing Matter?

Area of Science:

• Otolaryngology
• Neurosurgery
• Audiology

Background:

• Endoscopic stapedectomy is a surgical procedure to restore hearing in patients with otosclerosis.
• Various techniques are employed for oval window reconstruction, including fat grafts and blood patches.
• Optimizing oval window packing is crucial for successful surgical outcomes.

Purpose of the Study:

• To compare audiometric outcomes and postoperative vertigo following different oval window packing techniques after endoscopic stapedectomy.
• To evaluate the efficacy of lobular fat graft, promontory blood patch, combined techniques, other autologous materials, and no reconstruction.
• To identify the optimal method for oval window reinforcement in endoscopic stapedectomy.

Main Methods:

• Retrospective chart review of patients undergoing endoscopic stapedectomy between 2017 and 2023.
• Analysis of 256 ears, comparing outcomes across five oval window reconstruction techniques.
• Primary outcome measures included subjective vertigo, change in air-bone gap (ABG), and pure-tone average (PTA).

Main Results:

• No significant differences in vertigo incidence or average ABG/PTA improvements were observed between groups at initial or later follow-ups.
• While initial ABG closure to within 20 or 10 dB showed no difference, the promontory blood patch group achieved significantly better ABG closure to within 10 dB at the second postoperative visit.
• The promontory blood patch technique demonstrated a potential advantage in long-term hearing improvement.

Conclusions:

• Promontory blood patch reconstruction may lead to superior long-term air-bone gap closure compared to fat graft packing or no reconstruction.
• The choice of oval window reconstruction technique can influence long-term audiometric results after endoscopic stapedectomy.
• Further prospective studies may be warranted to confirm these findings.