Stapes surgery for tympanosclerotic stapes fixation: the hearing results, pneumolabyrinth, and other complications

Abstract

The hearing results after surgery for tympanosclerotic stapes fixation have been unsatisfactory. Stapedectomy for tympanosclerotic fixation seems more difficult than that for otosclerosis because most cases have fixation or erosion of the malleus and/or incus. In addition to difficulties associated with the available surgical technology, there is risk of deafness caused by internal otitis (because of poor hygiene of the tympanic cavity), and severe dizziness caused by a perilymphatic fistula and subluxation of the prosthesis into the vestibule.

We present the postoperative hearing results of 52 ears that were affected by tympanosclerotic stapes fixation. Stapes mobilization was performed on 33 ears in three treatment groups: small fenestra stapedectomy (SFS) using interposed 4-mm wire Teflon-piston between the incus and oval window was performed in eight ears; stapedotomy with interposed malleus attachment prosthesis (MAP) between the malleus and oval window in three ears; and stapedectomy with interposed total ossicular replacement prosthesis (TORP) between the tympanic membrane and oval window in eight ears. For ears with tympanosclerotic stapes fixation, we concluded that neither stapes mobilization nor SFS were effective for improving hearing, whereas stapedectomy with ossiculoplasty using TORP was very effective. However, the differences in the postoperative hearing gain and the air-bone gap among these three groups were not statistically significant.

When severe dizziness occurs postoperatively, CT is necessary to investigate the condition of the inner ear. It is essential to carefully evaluate such CT views for the existence and position of an air bubble in the inner ear and the degree of protrusion of the prosthesis into the labyrinth. Thus, CT images may be useful to predict the severity and prognosis of complications after surgery for tympanosclerotic stapes fixation.