[Diagnosis in persistent vertigo after stapes surgery]

One hundred sixty-two otosclerotic patients who underwent a stapedotomy between October 1991 and April 1994 were examined after experiencing postoperative vertigo. Twenty-eight complained of dizziness. In sixteen patients, we observed vertigo and nystagmus only within the first six postoperative days; in these cases, special treatment was not necessary. However, in twelve patients in whom vertigo persisted even after their stay in the hospital, the problem seriously affected their quality of life and their return to work. In these cases, an individualized diagnostic and therapeutic procedure was indicated. Case reports demonstrate the usefulness of several diagnostic methods (analysis of the case history, audiogram, investigation of the vestibular system, and elimination of non-vestibular causes of vertigo. But only high-resolution computed tomography scans of the temporal bone showed definite results. Air bubbles at the end of the prosthesis as indirect sign of perilymphatic fistula, bad position of the piston, new centers of otosclerosis, cicatrices, and in one case fracture of the prosthesis. Ten of the twelve patients required revision surgery. In most patients with persisting vertigo following stapedotomy, revision surgery was justified. However, high-resolution computed tomography is recommended.