Revision Stapedectomy: An Analysis of 201 Operations

Introduction: Recurrent or persistent conductive hearing impairment as well as vertigo or tinnitus after a stapes operation can be treated by means of stapes revision surgery. We analyzed stapes revisions performed during the last 15 years at our institution. The aim was to ascertain the causes that led to the failure, to analyze the postrevision results, and to compare them with data from the literature. Materials and Methods: This retrospective study analyzes 201 stapes revisions performed in 175 patients between 1992 and 2006. The indications, intraoperative findings, and surgical techniques were analyzed. Functional results were evaluated by means of hearing tests before and after surgery (1-15 yr). Revisions were mainly performed by the transcanal approach through the fixed speculum under local anesthesia using the fiber-optic argon laser and the Skeeter microdrill. Results: Indications for revision in 172 operations included lack of hearing improvement or recurrent conductive hearing loss. Six patients additionally had symptoms of vertigo. Sixteen patients experienced isolated vertigo despite improved hearing, 1 patient experienced intolerable tinnitus, and in 6 patients, the indication was deafness after stapedotomy. The most common intraoperative observations were prosthesis lateralization (53%), partial or total incus necrosis (33%), reossification of the footplate (31%), and loosening of the loop on the incus (9%). Hearing improved postoperatively in 88% of the patients. In 55% of the patients, there was a residual air-bone gap of 10 dB or less, and in 84%, the gap was 20 dB or less. Discussion: Stapes revisions are more challenging procedures with less perfect results compared with primary operations. Nevertheless, a postoperative hearing improvement was achieved in 88% of our patients. Modern techniques, such as the laser and microdrill, demonstrate their full usefulness.