title: Hearing Outcomes after Revision Stapedectomy Managed with Total Ossicular Prostheses.
abstract: OBJECTIVE
  (1) To describe the use of total ossicular prostheses (TOPs) in the setting of stapedectomy requiring an incus bypass procedure. (2) To analyze the short- and long-term audiometric results of TOP utilization in the setting of stapedectomy for an incus bypass procedure.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary neurotologic referral center.
  
  
  METHODS
  Seventeen cases of TOP reconstruction after stapedectomy were performed due to advanced incus erosion. The cases were assessed for pre- and postoperative bone conduction and air conduction pure-tone averages (PTAs; 0.5, 1, 2, 3 kHz), including high-tone bone conduction (1, 2, 4 kHz), air-bone gap, and speech discrimination scores. Hearing outcomes were measured: short-term (3 weeks) and long-term (average, 22 months).
  
  
  RESULTS
  Among 17 ears undergoing revision stapedectomy managed with TOP reconstruction, the average number of previous revision attempts was 1.0 (SD, 1; range, 1-5). The preoperative bone conduction PTA was 30.7 dB preoperatively, while the preoperative air conduction PTA was 64.3 dB. The mean postoperative air-bone gap significantly decreased to 18.9 dB (SD, 12.7; range, 5-46.25; P < .003) with a mean follow-up of 22.2 months (SD, 25.0; range, 0.75-78). No significant decrement in high-tone bone conduction PTA was observed (mean, 0 dB; SD, 12.8; range, -36.7 to 20; P = .427); however, 1 ear revealed a severe decrease in PTA and speech discrimination score postoperatively. No further revisions were noted in follow-up.
  
  
  CONCLUSIONS
  TOP reconstruction in the setting of previous revision stapedectomy with limited incudovestibular reconstructive options may lead to favorable hearing outcomes, but it carries an increased risk of sensorineural hearing loss.
authors.affiliation: House Ear Clinic, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
authors.forename: J Eric
authors.initials: JE
authors.lastname: Lupo
authors.affiliation: University of Southern California Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Strickland
authors.affiliation: House Ear Clinic, University of Southern California Keck School of Medicine, Los Angeles, California, USA University of Southern California Keck School of Medicine, Los Angeles, California, USA jhouse@houseclinic.com.
authors.forename: John W
authors.initials: JW
authors.lastname: House
mesh_terms: D001299:Audiometry; D001844:Bone Conduction / Q000502:physiology; D005260:Female; D006309:Hearing / Q000502:physiology*; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D011183:Postoperative Complications; D012086:Reoperation; D013067:Speech Perception; D013201:Stapes Surgery / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: otosclerosis; reconstruction prosthesis; revision stapedectomy