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.