Twenty-year review of revision stapedectomy.
OBJECTIVE
To evaluate surgical findings and techniques, patient management techniques, and audiometric results of 522 revision stapedectomies.


METHODS
Retrospective chart review.


METHODS
Tertiary otologic referral center.


METHODS
A total of 522 revision stapedectomies over a 20-year period in Warren, Ohio, and Israel. The audiologic criterion for revision was an air-bone gap greater than 20 dB over the three-frequency range 0.5 to 2 kHz.


RESULTS
Of the 522 revision cases, a total of 483 patients were operated on to improve hearing. The remainder of the patients were operated on for various other noted reasons. Closure of the air-bone gap to within 10 dB was achieved in 71% of patients (343 of 483). The mean pure-tone average improvement was 17.8 dB, with an average postoperative air-bone gap of 7.3 dB. The most common surgical findings were prosthesis malfunction at the oval window, incus, or both (58%). Since beginning the use of the Argon laser for surgical problems, the success rate has increased to 80%. A subgroup of 35 Argon laser revision stapedectomies resulted in a larger hearing gain (25.2 dB) and 91.4% closure of the air-bone gap to less than 10 dB.


CONCLUSIONS
More than 70% of revision stapedectomy cases for hearing improvement have had successful closure of their air-bone gap. Since the introduction of the laser 5 years ago, the success rate has increased to 80%. In those specific cases where the laser was required, the success rate increased to 91.4%. Regardless of the revision technique, hearing results were the least successful when the incus could not be used for reconstruction.
Lippy
William H
WH
Lippy Group for Ear, Nose and Throat, Warren, Ohio 44484, USA. whlmd@aol.com
Battista
Robert A
RA
Berenholz
Leonard
L
Schuring
Arnold G
AG
Burkey
John M
JM
D000818:Animals; D004867:Equipment Design; D005276:Fenestration, Labyrinth / Q000009:adverse effects; D020342:Finite Element Analysis; D006309:Hearing; D006801:Humans; D008962:Models, Theoretical; D009998:Ossicular Prosthesis / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D013201:Stapes Surgery