Stapes Surgery Outcomes: The Practice of 35 Years

Abstract

Objective: The objective of this study was to review patients who underwent stapes surgery in the Hacettepe University Ear Nose Throat and Head and Neck Surgery Department with subgroups, such as type of surgery, prosthesis used in the surgery, rate of revision, and audiological results.Methods: The data of 35 years were searched, and it was detected that 327 patients (190 females, 137 males) had undergone stapes surgery; the age was ranging between 11-70 years (mean: 39).In our clinic, stapes surgery is performed mostly by transmeatal incision. After entering the middle ear, we almost always look for stapes mobility. If there is mobility in the incus and malleus and no mobility in the stapes, a small fenestra is performed as stapedotomy and prosthesis and placed between the stapedotomy fenestra and incus long arm. To cover the space near the stapedotomy, small bony fragments are placed. In patients who had preoperative and postoperative audiograms, the mean value of 500, 1000, 2000, and 4000 Hz air-bone conduction thresholds of 199 cases were measured and compared.Results: In 62% of 327 patients who were operated on, the air-bone gap was less than 10 dB, less than 15 dB in 88%, and less than 20 dB in 94%. In 6% of patients, there was air-bone conduction gap of more than 20 dB. Revision surgery was performed in 20 patients. Of them, air-bone gap closure was achieved in 60%. One patient had sudden sensorineural hearing loss. There was also a perilymph fistula in one patient who had vertigo.Stapedotomy and using a Teflon piston with autogenous bone are successful methods of recovering conductive- type hearing loss in otosclerosis. In patients with advanced sensorineural hearing loss, a very low air-bone gap or unmeasured air-bone gap is not a contraindication.Conclusion: Stapes surgery (stapedectomy or stapedotomy) is a successful surgery in the case of conductive- type hearing loss with otosclerosis. Complications, such as total sensorineural hearing loss, facial nerve paralysis, and perilymph fistula, could be seen at variable rates, and the surgeon should be cautious, and the patients must be informed about these complications in the pre-operative period.

Keywords

• stapes
• stapedotomy
• teflon prosthesis
• juvenile otosclerosis