Success rate in revision stapes surgery for otosclerosis.
OBJECTIVE
The aim of this study was to evaluate the hearing results of revision stapes surgery performed because of previously failed operations and to determine the causes of failure.


METHODS
Retrospective review of revision stapes operations.


METHODS
Tertiary referral center.


METHODS
Sixty-three consecutive revision stapes operations were performed in 56 patients over a period of 12 years (1992-2004). The indication for revision surgery was recurrent or persistent air-bone gap greater than 20 dB after primary surgical treatment of otosclerosis of the oval window.


RESULTS
All patients were operated on to improve hearing. Sixty-three revision stapes operations resulted in closure of the air-bone gap to 10 dB or less in 52.4% of cases. The average postoperative air-bone gap was 13.1 dB, and the mean pure-tone average improvement was 12.9 dB. In six patients (9.5%), revision surgery produced no change in hearing, and in four (6.3%) the hearing decreased by 5 dB or more. In one patient, the operation resulted in a profound hearing loss. Prosthesis malfunction was the most common primary cause of failure (60.3%). The original prosthesis was replaced with a new one in 48 cases. In 30 of these (62.5%), closure of the air-bone gap to within 10 dB was achieved. In 15 cases, the prosthesis was not replaced, and in only four of these (26.7%), closure of the air-bone gap within 10 dB was obtained (p < 0.022).


CONCLUSIONS
Revision stapes surgery is less likely to be successful than the primary operation. Closure of the air-bone gap to within 10 dB was achieved in 52.4% of patients. The success rate was better in cases where the original prosthesis was replaced with a new one. The risk for decreased bone-conduction threshold does not seem to be higher than in primary surgery.
Gros
Anton
A
Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, Zaloska 2, Ljubljana, Slovenia. anton.gros@guest.arnes.si
Vatovec
Jagoda
J
Zargi
Miha
M
Jenko
Klemen
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D001844:Bone Conduction / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D010040:Otosclerosis / Q000503:physiopathology / Q000601:surgery*; D010046:Oval Window, Ear / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013201:Stapes Surgery; D017211:Treatment Failure