Revisions after prior stapes surgery: aspects on indication, intraoperative findings and surgical strategies.

Abstract

Objective: Primary stapes surgery is considered a challenging intervention in ear surgery. Despite an risk of deafness in 0.5-1 percent, this procedure has still a good benefit-risk ratio due to the improvement in hearing and quality of life that is usually achieved. However, revision after prior stapes surgery is considered even more challenging. Revisions after stapes surgery are very heterogeneous procedures, both in terms of the indication and the surgical strategy and are generally considered to be significantly more demanding. Reasons for complications after prior stapes surgery as well as strategies for successful revisions are not well described in the literature.

Methods: Retrospective cohort study, tertiary referral center. 124 cases of revisions after prior stapes surgery were identified between 2011-2022 and are analyzed based on biographic data, clinical, audiological, and intraoperative findings as well as the eventual therapy. Cases were analyzed regarding indication, intraoperative finding and the surgical strategy chosen.

Results: Acute, subacute, and long-term complications of the primary intervention as well as other incidental reasons such as progressive hearing loss can be identified as indication for revision surgery. Preoperative clinical findings were correlated to intraoperative findings and surgical strategies. Audiological results are discussed.

Conclusions: Different recommendations for the indication of a surgical revision can be derived depending on the individual preoperative case history and findings. In addition, there are patterns regarding the chances of success of a revision, especially in cases of persistent conductive hearing loss chances of hearing improvement seem possible in more than 80% of cases.