Post-stapedectomy granuloma: a devastating complication.
OBJECTIVE
This paper reports three cases of severe post-stapedectomy granuloma, emphasising the variable presentation of this devastating complication and the challenges of its management.


METHODS
A retrospective review was conducted of three cases of post-stapedectomy granuloma requiring surgical debulking between 2010 and 2015. Clinical symptoms, serial imaging, histopathology and post-operative outcomes were considered.


RESULTS
Intra-operatively, extensive granulation tissue with erosion of the otic capsule was found. There was spread along the VIIth and VIIIth cranial nerves to the cochlear nucleus in one patient. Post-operative clinical improvement was demonstrable, corroborated by diminution of contrast enhancement on serial magnetic resonance imaging. Facial nerve function recovered, tinnitus amelioration was variable and some otalgia persisted. Post-operative complications included grade IV facial weakness and late Pseudomonas aeruginosa meningitis, which all resolved.


CONCLUSIONS
To the authors' knowledge, this paper reports the only case of post-stapedectomy granuloma tracking to the brainstem. Otalgia was present in all our cases, and may be deemed a red flag symptom of progressive bony destruction and otic capsule involvement. Although granuloma remains rare, it should be considered in any patient with worsening otological symptoms following stapes surgery.
ENT Department,Queen Elizabeth Hospital Birmingham,UK.
E
E
Watts
ENT Department,Royal National Throat, Nose and Ear Hospital,London,UK.
H R F
HRF
Powell
ENT Department,Royal National Throat, Nose and Ear Hospital,London,UK.
S R
SR
Saeed
ENT Department,Queen Elizabeth Hospital Birmingham,UK.
R M
RM
Irving
D000328:Adult; D001927:Brain Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D001933:Brain Stem / Q000473:pathology / Q000601:surgery; D004433:Earache / Q000209:etiology; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006097:Granulation Tissue / Q000473:pathology / Q000601:surgery; D006099:Granuloma / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000009:adverse effects*; D014012:Tinnitus / Q000209:etiology
Post-Stapedectomy Granuloma; Reparative Granuloma