Discussion:(4)
Primary findings: Revision stapedotomy is avaluable
treatment option in case of unsatisfactory hearing results after primary
stapedotomy.However, our results – in consensus with other data – show
that audiological outcomes in these cases are still inferior to primary
surgeries.From this standpoint, the efficacy of the first operation is
extremely importantin stapes surgery.
The experience duringrevision surgeries could be helpful in
understanding the reasons behind unsatisfactory results. In our series,
periprosthetic adhesions were the leading cause behind mechanical
failures.Adhesive processes were not only very common, their negative
impact on hearing results was the same as that of any other
prosthesis-related complication. Furthermore,after revision surgery, in
the presence of intratympanic adhesions,audiological resultswere not
superiorcomparedto theremaining cases. The difficulty of managing
patients with adhesions was described previously in the literature(4).
This finding highlights the importanceof the most atraumatic surgical
technique, the preservation of intact intratympanic mucosa, and the
prevention of post-surgical scar tissue formation.
Using perioperative corticosteroid treatment to prevent postoperative
fibrosis is already a topic of discussion(8). Our group was the first to
describethat the above adjuvant treatment contributes to a significantly
better ABG closure after primary CO2laser stapedotomy
compared to the control group(9).Our assumption was that
thiscontribution is manifested through the prohibition of scar tissue
formation.