Mediterr J Otol 2005:1(1):14-19.

Stapes surgery: a review of 515 cases

Simoncelli C., Ricci G., Trabalzini F., Gullà M., Faralli M., Molini E.

Department of Otosurgery, Clinica Otorinolaringoiatrica Via Enrico Dal Pozzo 06126 – Perugia – Italy  otorino@unipg.it

OBJECTIVES: The object of this study was to review patients who underwent stapes surgery during a 15-year period, together with an evaluation of techniques, results, and complications.

PATIENTS AND METHODS: Otosclerosis surgery was performed in 483 adult patients (305 females, 178 males; mean age 46.3 years; range 24 to 74 years) between 1988 and 2002. The disease was bilateral in 292 patients (60.5%) and unilateral in 191 patients (39.5%). Operations were unilateral in 451 patients, and bilateral in 32 patients, and included small fenestra stapedotomy with a perforation of 0.8 mm (442 ears, 85.8%), partial stapedectomy with removal of the posterior half of the footplate (30 ears, 5.8%), and total stapedectomy (43 ears, 8.4%. A Teflon prosthesis, 0.6 mm in diameter and 4-4.5 mm length, was used nearly in all the cases. In cases of stapedectomy, a perichondrial graft was placed over the oval window. Preoperative and postoperative hearing levels (frequencies 500, 1000, 2000, and 3000 Hz) and air- and bone-conduction thresholds (frequencies 250, 500, 1000, 2000, and 4000 Hz) were measured. Postoperative closure of the air-bone gap was evaluated in four groups: grade A (gap≤10 dB HL), grade B (11-20 dB HL), grade C (21-30 dB HL), and grade D (>30 dB HL). The results were evaluated in accordance with the guidelines of the Committee on Hearing and Equilibrium-1995. Of 515 operations, 380 were evaluative (73.8%) with respect to outcome. The mean follow-up period was 68 months (range 3 to 180 months).

RESULTS: Of 380 evaluative operations, 307 ears (80.8%) showed complete recovery with a postoperative air-bone gap less than 10 dB (grade A), whereas 10 ears (2.6%) showed no improvement in hearing thresholds and in the closure of the air-bone gap. Together with partial recoveries (grade B and C), the overall improvement in hearing thresholds was 97.3%. The mean preoperative and postoperative air-conduction hearing thresholds at frequencies of 500, 1000, 2000, and 3000 Hz were 56.3±14.5 dB HL and 28.3±9.7 dB HL, respectively. The mean gain for air conduction at the same frequencies was 25.3±11.7 dB HL. Of 10 ears in which no hearing recovery was observed, two ears rapidly developed sensorineural hearing loss. Revision surgery was performed in six of the remaining ears and resulted in complete response. Of these, air-bone gap closure was achieved in three ears, while one ear developed sensorineural hearing loss a few days after revision surgery. The most common complications encountered intraoperatively, and in the immediate and late postoperative periods were section of the chorda tympani (n=130, 25.2%), transient facial nerve paralysis (n=13, 2.5%), and sensorineural hearing loss (n=2, 0.4%), respectively.

CONCLUSION: Our results show that stapes surgery yields very good functional results, with complete or partial closure of the air-bone gap in the great majority of cases, and with very low rates of postoperative complications.