Revision stapes surgery after otosclerosis

Česká verzia

Authors: V. Souček ¹; M. Navara ^2,3; Š. Zavázalová ²; J. Bouček ¹; J. Astl ^2,3
Authors place of work: Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN v Motole, Praha ¹; Klinika otorinolaryngologie a maxilofaciální chirurgie 3. LF UK a ÚVN Praha ²; 3. lékařská fakulta, Univerzita Karlova, Praha ³
Published in the journal: Otorinolaryngol Foniatr, 73, 2024, No. 4, pp. 220-226.
Category: Original Article
doi: https://doi.org/10.48095/ccorl2024220

Summary

Introduction: Otosclerosis is a multifactorial disease, characterized by growth of abnormally changed bone in the otic capsule. The primary stapedotomy is an effective treatment of conductive hearing loss with a success rate of 72–94%. The aim of the study was to determine the success of revision surgery depending on the type of primary surgery and an overview of perioperative findings in connection with probable primary failure. Methods: 38 revisions indicated for otosclerosis after stapes surgery in 2001–2015 were included in the retrospective study. Air and bone conductive thresholds, pure tone average (PTA), air-bone gap (ABG) at 500–2,000 Hz, as well as speech recognition threshold (SRT) were evaluated, and results were compared preoperatively and postoperatively. Results: ABG closure under 20 dB was achieved in 30 (78.9%) out of 38 patients with an average improvement in postoperative PTA of 15 dB. Twenty-three patients (61.5%) had SRT improved after surgery by more than 10 dB, but only 13 improved by more than 20 dB. After dividing the group according to previous performance, ABG closure to 20 dB was achieved in 100% revisions after previous stapedectomy with Schuknecht prosthesis (N = 12); in 69.6% (17 cases), revisions after stapedotomy were done with piston insertion (N = 24). Five patients (20.8%) had slightly impaired hearing postoperatively. The most common perioperative finding was a dislocated prosthesis in 12 cases (25.5%) and adhesions of the long process of the incus (DVK) with fixation to the middle ear cavity in 6 cases (12.8%). DVK erosion was present in 5 patients (10.6%). Conclusion: Success of revision surgery depends on the type of previous performance. Due to the difficulty, reduced success rate, and increased risks of surgery, it should be performed by an experienced surgeon.

Keywords:

revision – stapes surgery – stapedotomy – stapedectomy – stapes prosthesis – otosclerosis

Zdroje

1. Tomek MS, Brown MR, Mani SR et al. Localization of a gene for otosclerosis to chromosome 15q25–q26. Hum Mol Genet 1998; 7 (2): 285–290. Doi: 10.1093/hmg/7.2.285.

2. Van Den Bogaert K, Govaerts PJ, De Leenheer EM et al. Otosclerosis: a genetically heterogeneous disease involving at least three different genes. Bone 2002; 30 (4): 624–630. Doi: 10.1016/s8756-3282 (02) 00679-8.

3.Školoudík L, Chrobok V, Dršata J. Choroby vnitřního ucha. In: Chrobok V, Komínek P, Plzák J et al. Otorinolaryngologie a chirurgie hlavy a krku. 1st ed. Havlíčkův Brod: Tobiáš 2022.

4. Skrivan J, Cada Z, Kluh J et al. Revision operations after previous stapes Sumery for persisting hearing loss. Bratisl Lek Listy 2014; 115: 442–444.

5. Wegner I, Vincent R, Derks LSM et al. An internally validated prognostic model for success in revision stapes surgery for otosclerosis. Laryngoscope 2018; 128 (10): 2390–2396. Doi: 10.1002/lary.27132.

6. Hlaváček V, Chládek V. Otoskleróza. Praha: SZdN 1958.

7. Purohit B, Hermans R, Op de Beeck K. Imaging in otosclerosis: A pictorial review. Insights Imaging 2014; 5 (2): 245–252. Doi: 10.1007/s13244-014- 0313-9.

8. Gristwood RE, Venables WN. Otosclerosis and chronic tinnitus. Ann Otol Rhinol Laryngol 2003; 112 (5): 398–403. Doi: 10.1177/000 348940311200502.

9. Lopponen H, Laitakari K. Carhart notch effect in otosclerotic ears measured by electric bone-conduction audiometry. Scand Audiol Suppl 2001; 52: 160–162. Doi: 10.1080/01050 3901300007399.

10. Pellant A, Chrobok V. Otoskleróza včera a dnes. Postgradual Med 2004; 6 (4): 390–394.

11. Bittermann AJ, Rovers MM, Tange RA et al. Primary stapes surgery in patients with otosclerosis: prediction of postoperative outcome. Arch Otolaryngol Head Neck Surg 2011; 137 (8): 780–784. Doi: 10.1001/archoto.2011.100.

12. Blijleven EE, Wegner I, Tange RA et al. Revision Stapes Surgery in a Tertiary Referral Center: Surgical and Audiometric Outcomes. Ann Otol Rhinol Laryngol 2019; 128 (11): 997–1005. Doi: 10.1177/0003489419853304.

13. Kisilevsky VE, Dutt SN, Bailie NA et al. Hearing results of 1145 stapedotomies evaluated with Amsterdam hearing evaluation plots. J Laryngol Otol 2009; 123 (7): 730–736. Doi: 10.1017/S0022215109004745.

14. Goodhill V. Stapes mobilization for otosclerotic deafness; the monitored peribasal technique. Calif Med 1958; 88 (2): 114–122.

15. Schuknecht HF, Oleksiuk S. The metal prosthesis for stapes ankylosis. AMA Arch Otolaryngol 1960; 71: 287–295. Doi: 10.1001/archotol. 1960.03770020159021.

16. Profant M, Kuniak B, Klačanský J. Stapedotómia laserom. Čs Otolaryng 1993; 42: 217–221.

17. Özüer MZ, Olgun L, Gultekin G. Revision stapes surgery. Otolaryngol Head Neck Surg 2012; 146 (1): 109–113. Doi: 10.1177/01945998114 23523.

18. Lippy WH, Battista RA, Berenholz L et al. Twenty-year review of revision stapedectomy. Otol Neurotol 2003; 24 (4): 560–566. Doi: 10.1097/00129492-200307000-00005.

19. Magliulo G, Cristofari P, Terranova G. Functional hearing results in revision stapes surgery. Am J Otol 1997; 18 (4): 408–412.

20. Puxeddu R, Ledda GP, Pelagatti CL et al. Revision stapes surgery for recurrent transmissional hearing loss after stapedectomy and stapedotomy for otosclerosis. Acta Otorhinolaryngol Ital 2005; 25 (6): 347–352.

21. Kanona H, Bhutta MF, Lavy J. Our approach to revision stapes surgery and the outcomes from 49 procedures at a UK tertiary centre. Clin Otolaryngol 2017; 42 (4): 931–935. Doi: 10.1111/coa.12769.

22. Rocher PF, Galofre DJ, Puchaledes MV et al. Revicion Stapedectomy. Acta Otorinolaringol Esp 2017; 58 (2): 48–51.

23. Berenholz L, Lippy W, Harell M. Revision stapedectomy in Israel. Otol Neurotol 2002; 23 (6): 850–853. Doi: 10.1097/00129492-200211000- 00007.

24. Marchica CL, Saliba I. The Relationship between Stapes Prosthesis Length and Rate of Stapedectomy Success. Clin Med Insights Ear Nose Throat 2015; 24 (8): 23–31. Doi: 10.4137/CMent.s27284.

25. Hahn Y, Diaz R, Hartman J, Bobinski M, Brodie H. Assessing stapes piston position using computed tomography: a cadaveric study. Otol Neurotol 2009; 30 (2): 223–230. Doi: 10.1097/MAO.0b013e31818de5cd.

26. Lesinski SG. Causes of conductive hearing loss after stapedectomy or stapedotomy: a prospective study of 279 consecutive surgical revisions. Otol Neurotol 2002; 23 (3): 281–288. Doi: 10.1097/00129492-200205000-00009.

27. Vincent R, Rovers M, Zingade N et al. Revision stapedotomy: operative findings and hearing results. A prospective study of 652 cases from the Otology-Neurotology Database. Otol Neurotol 2010; 31 (6): 875–882. Doi: 10.1097/MAO.0b013e3181e8f1da.

28. Fletcher H. A method of calculating hearing loss for speech from an audiogram. Acta Otolaryngol Suppl 1950; 90: 26–37. Doi: 10.3109/00016485009127735.

29. Novák A, Vokřál J, Dlouhá O. Vztah PTA a SRT (Pure Tone Average – průměrná tónová ztráta, Speech Recognition Threshold – hladina srozumitelnosti řeči). Otorinolaryngol Foniatr 2008; 57 (4): 201–205.

30. Srivastava R, Cho W, Fergie N. The Use of Lasers in Stapes Surgery. Ear Nose Throat J 2021; 100 (1_suppl): 73S–76S. Doi: 10.1177/0145 561320937828.

ORCID autorů

Š. Zavázalová 0000-0002-2710-119X,

J. Bouček 0000-0002-9233-6702,

J. Astl 0000-0002-8022-0200.

Přijato k recenzi: 31. 7. 2024

Přijato k tisku: 15. 10. 2024

MUDr. Vratislav Souček

Klinika otorinolaryngologie a chirurgie hlavy a krku

1. LF UK a FN v Motole

V Úvalu 84

150 06 Praha 5

vratislav.soucek@fnmotol.cz