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Primary Endoscopic Stapes Surgery: Audiologic and Surgical Outcomes

Nassiri, Ashley M.*; Yawn, Robert J.*; Dedmon, Matthew M.*; Tolisano, Anthony M.; Hunter, Jacob B.; Isaacson, Brandon; Rivas, Alejandro*

doi: 10.1097/MAO.0000000000001958
OTOSCLEROSIS

Objective: Evaluate outcomes following primary endoscopic stapes surgery.

Study Design: Retrospective case series.

Setting: Two tertiary otologic centers.

Patients: Eighty-one ears with surgically confirmed stapes fixation.

Interventions: Total endoscopic stapedotomy or stapedectomy.

Main Outcome Measures: Surgical and audiologic outcomes.

Results: Eighty-one subjects were included (60% women) with a median age of 47.6 years (range, 19.1–73.6 yr). Etiologies of hearing loss included otosclerosis (96.3%), stapedial ankylosis (2.5%), and congenital stapes fixation (1.2%). The median follow-up was 5.3 months (range, 1.2–50.4 mo). 74.1% required scutum removal, and the chorda tympani nerve was sacrificed in 7.4%. Two techniques were used: 51.9% underwent stapedectomy and 48.1% underwent stapedotomy (with use of laser, drill, or both in 74.4, 20.5, and 5.1% of cases, respectively). The median air-bone gap (ABG) improved from 31.3 dB preoperatively to 6.25 dB postoperatively at last follow-up (p < 0.0001). The ABG closed to less than 15 dB in 96.3% of patients and less than 10 dB in 84%. There were no instances of postoperative sensorineural hearing loss (defined as >15 dB change from baseline) or facial nerve injury. Postoperatively, 29.6% of patients reported dysgeusia, of which 8.3% was persistent at last follow-up. Postoperative disequilibrium was reported in 17.3% of cases, with 100% resolution at last follow-up. Comparison of the stapedotomy and stapedectomy groups revealed no significant differences in audiologic or surgical outcomes.

Conclusions: Endoscopic stapedotomy and stapedectomy are effective techniques to manage stapes fixation resulting in a median postoperative ABG of 6.25 dB and ABG closure to within 10 dB in 84% of patients.

*Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee

Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas

Address correspondence and reprint requests to Alejandro Rivas, M.D., Department of Otolaryngology–Head and Neck Surgery, The Bill Wilkerson Center for Otolaryngology & Communication Sciences, 7209 Medical Center East, South Tower, 1215 21st Avenue South, Nashville, TN 37232-8605; E-mail: alejandro.rivas@vanderbilt.edu

Institutional review board approval: Vanderbilt University IRB Approval #: 171214, UTSW IRB Approval #: STU 022012-060.

Financial material and support: No funding or other support was required for this study.

Conflicts of interest to declare: Alejandro Rivas: Consultant for MED-EL, Advanced Bionics, Cochlear, Grace Medical, Stryker, Cook Medical, and Olympus.

Brandon Isaacson: On the advisory board for MED-EL & Advanced Bionics. Consultant for Stryker, Storz, Olympus, Medtronic.

Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company