Revision stapedectomy for otosclerosis: report of 73 cases

OBJECTIVE: The aim of this study was to determine causes and evaluate results of revision stapedectomy. DESIGN: Retrospective review of 73 revision stapedectomies. SETTING: Revision stapedectomies were performed in two tertiary otolaryngology departments (Fondation Adolphe de Rothschild, Paris, France, and Cliniques universitaires Saint-Luc, Bruxelles, Belgium). METHODS: Patients characteristics, indications for revision, intraoperative findings, and hearing results were noted. MAIN OUTCOME MEASURES: Hearing results were reported as recommended by the American Academy of Otolaryngology-Head and Neck Surgery. We also reported hearing results with and without the use of a laser. RESULTS: Conductive hearing loss was the main indication for revision (78%). Mean intraoperative findings included prosthesis malfunction (50%), fibrous adhesions (32.8%), incus necrosis (8.5%), and otosclerotic regrowth (7%). When revision was performed because of cochleovestibular complication, middle ear exploration revealed three findings: oval window granuloma (30.7%), perilymphatic fistula (30.7%), and a too long prosthesis (23%). Postoperative air-bone gap (ABG) was closed to less than 10 dB in 51.5% of cases and to less than 20 dB in 68.7% of cases, with 9% of sensorineural hearing loss (not exceeding 15 dB in 80% of cases). The use of an argon laser in 14 patients (19%) showed slightly better hearing results (postoperative ABG < 10 dB in 61.5% of cases and < 20 dB in 77% of cases), but this difference was not statistically significant compared with patients operated on without the use of a laser. CONCLUSION: The results of this series are comparable with previously published studies. Revision stapes surgery is not as successful as primary stapedectomy, but good gap closure can be expected in two-thirds of cases with an experienced surgeon.