Stapedectomy revision following sensorineural hearing loss

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Innovation

Background:

• Sensorineural hearing loss following stapedectomy necessitates revision surgery.
• Oval window fistulas are a suspected cause of post-stapedectomy hearing loss.
• Comparing stapedectomy prosthesis types is crucial for surgical outcomes.

Purpose of the Study:

• To analyze outcomes of revision stapedectomies after initial stapedectomies resulted in sensorineural hearing loss.
• To compare the efficacy and complications of two primary stapedectomy techniques: Robinson prosthesis with vein graft versus wire prosthesis with Gelfoam.
• To provide surgical guidance for revision stapedectomies.

Main Methods:

• Analysis of 71 cases undergoing revision stapedectomy for sensorineural hearing loss.
• Categorization of cases based on initial stapedectomy technique: Robinson prosthesis (stainless steel, vein graft) or wire prosthesis (with Gelfoam).
• Evaluation of surgical findings, including fistula rates, prosthesis length, and post-revision dizziness.

Main Results:

• The wire prosthesis group exhibited a fistula rate 10 times higher than the Robinson prosthesis group.
• Excessive prosthesis length was found in 21% of wire prosthesis cases, but not with Robinson prostheses.
• Dizziness improvement post-revision stapedectomy was observed in 20% (Robinson), 60% (wire), and 75% (fistula) of patients.

Conclusions:

• The Robinson prosthesis demonstrates a lower fistula rate and fewer issues with excess length compared to wire prostheses.
• Revision stapedectomy techniques should consider prosthesis type and potential for oval window fistula.
• Findings guide surgical decisions for revision stapedectomy to improve patient outcomes.