Primary Endoscopic Stapes Surgery: Audiologic and Surgical Outcomes

OBJECTIVE: Evaluate outcomes following primary endoscopic stapes surgery.

STUDY DESIGN: Retrospective case series.

SETTING: Two tertiary otologic centers.

PATIENTS: Eighty-one ears with surgically confirmed stapes fixation.

INTERVENTIONS: Total endoscopic stapedotomy or stapedectomy.

MAIN OUTCOME MEASURES: Surgical and audiologic outcomes.

RESULTS: Eighty-one subjects were included (60% women) with a median age of 47.6 years (range, 19.1-73.6 yr). Etiologies of hearing loss included otosclerosis (96.3%), stapedial ankylosis (2.5%), and congenital stapes fixation (1.2%). The median follow-up was 5.3 months (range, 1.2-50.4 mo). 74.1% required scutum removal, and the chorda tympani nerve was sacrificed in 7.4%. Two techniques were used: 51.9% underwent stapedectomy and 48.1% underwent stapedotomy (with use of laser, drill, or both in 74.4, 20.5, and 5.1% of cases, respectively). The median air-bone gap (ABG) improved from 31.3 dB preoperatively to 6.25 dB postoperatively at last follow-up (p < 0.0001). The ABG closed to less than 15 dB in 96.3% of patients and less than 10 dB in 84%. There were no instances of postoperative sensorineural hearing loss (defined as >15 dB change from baseline) or facial nerve injury. Postoperatively, 29.6% of patients reported dysgeusia, of which 8.3% was persistent at last follow-up. Postoperative disequilibrium was reported in 17.3% of cases, with 100% resolution at last follow-up. Comparison of the stapedotomy and stapedectomy groups revealed no significant differences in audiologic or surgical outcomes.

CONCLUSIONS: Endoscopic stapedotomy and stapedectomy are effective techniques to manage stapes fixation resulting in a median postoperative ABG of 6.25 dB and ABG closure to within 10 dB in 84% of patients.