[Late deterioration in bone conduction after stapes surgery: a retrospective analysis].
In spite of the well-consolidated technique that otosclerosis surgery has built up, there are several aspects that have yet to be satisfactorily explained. One of these is the greater long-term "vulnerability" that appears to characterize an ear that has been operated on compared to a healthy one. In searching for a feasible explanation of this phenomenon and its therapeutic implications, a retrospective analysis of 26 cases was carried out on patients who had been operated between 1966 and 1995 and had come to our attention between 1989 and 1999 due to a rapid, late deterioration in bone conduction. Short-term treatment was pharmacological and surgical in 19 cases and exclusively pharmacological in 7 cases. The analysis of the results of therapy was based on an evaluation criterion of PTA (250-4000 Hz) > 5 dB, calculated on the basis of the bone conduction threshold values. Possible prognostic factors were searched for by means of a multivariate analysis that took as its dependent variable the bone conduction hearing threshold following therapy and as independent variables the age, gender, monolaterality of the otosclerosis ascertained, a positive medical history for analogous phenomena and for previous surgical revision, concomitant vertigo, the time that had elapsed between initial treatment (operation) and deterioration, the technique adopted during the first operation, the extent of the rapid deterioration, the audiometric characteristics at the outset of treatment for the acute episode, the time that had elapsed between deterioration and treatment, the type of treatment, possible reopening of the oval window, and intraoperative findings of a perilymphatic fistula. In the 7 cases managed with pharmacological therapy alone, improvement was seen in 3 cases while the condition remained unvaried in 4 cases; surgical revision (which in 5 cases enabled the presence of a fistula to be ascertained) associated with pharmacological therapy brought improvement in 4 cases, worsening in 4 cases, and no variation of the condition in 11 cases. The only prognostic factor detected, of an unfavourable nature, was the presence of anacusis upon examination. The results obtained do not enable unambiguous conclusions to be drawn: it may in any case be inferred that, at least in certain particular cases, above all when a false cochlear deterioration or the presence of a fistula is suspected, an "aggressive" therapeutic approach may be justified.
Pirodda
A
A
Dipartimento di Scienze Chirurgiche ed Anestesiologiche, Sezione di Otorinolaringoiatria, Università di Bologna, Policlinico S. Orsola-Malpighi, Bologna. apirodda@unibo.it
Modugno
G C
GC
Stamato
R
R
Montaguti
M
M
Ceroni
A Rinaldi
AR
D000328:Adult; D000368:Aged; D001844:Bone Conduction / Q000502:physiology*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013199:Stapes / Q000473:pathology*; D013201:Stapes Surgery; D013997:Time Factors