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Outcomes of Stapedotomy With Heat-Crimped Prostheses

Murfee, John*; O’Connell, Brendan; Haynes, David; Rivas, Alejandro; Dedmon, Matthew; Bennett, Marc

doi: 10.1097/MAO.0000000000001987
OTOSCLEROSIS

Background: Theoretical disadvantages are associated with the use of heat-crimped piston prostheses in stapedotomy. Loose crimping could result in prosthesis displacement or slippage. Alternatively, overly tight crimping may cause trauma to the incus with resultant necrosis.

Objectives: 1) Analyze outcomes of patients undergoing stapedotomy with heat-activated piston-style prostheses, and 2) compare outcomes between prostheses made by different manufacturers.

Study Design: Retrospective.

Setting: Vanderbilt Medical Center.

Patients and Methods: Cases undergoing stapedotomy between 2005 and 2016 were reviewed. Audiometric assessments were recorded in accordance with American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) guidelines. Patients who lacked audiometric follow-up before 6 months or after 1 year were excluded.

Intervention(s): Diagnostic, therapeutic, and rehabilitative.

Main Outcome Measure(s): Postoperative air-bone gap (ABG) and achievement of an ABG is less than or equal to 10 dB.

Results: Three hundred fifty-eight patients met inclusion criteria. At short-term follow-up (<6 mo), the mean ABG was 11 ± 8 dB in the entire cohort; this did not differ based on manufacturer (p = 0.13). The majority of patients (63%) achieved an ABG less than or equal to 10 dB. At longer-term follow-up, the mean ABG was 9 ± 7 dB; again no differences were noted when comparing prosthesis manufacturer (p = 0.20). 70% of patients achieved an ABG less than or equal to 10 dB at longer-term follow-up. When comparing short- to long-term follow-up, ABG did not significantly change over time (p = 0.76). The overall revision rate was 1.9% (n = 7).

Conclusion: Favorable hearing outcomes are obtained both short- and long-term following stapedotomy and placement of heat-crimped piston prostheses. Both prosthesis groups appear stable in the middle ear environment long-term, as evidenced by a 1.9% revision rate among them.

*Quillen College of Medicine, Johnson City

Vanderbilt University, Nashville, Tennessee

Address correspondence and reprint requests to John Murfee, MS-III, Vanderbilt University, Nashville, TN 37232; E-mail: murfeejack@gmail.com

The authors disclose no conflicts of interest.

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