Ethical approval
This research was approved by ’[removed for blind peer review].For
this type of study, formal consent is not required.
Patients: A retrospective case series study of
25revision stapedotomy was performed. The surgeries were carried out
between 2013-2020,at the Department of Oto-Rhino-Laryngology, Head and
Neck Surgery [removed for blind review]. The indication for revision
was 10 dB or higher persistent ABG-PTA. The presumed preoperative
clinical diagnosis of stapes fixation before primary intervention was
made by PTA testing, tympanometry, stapedius reflex, and physical
examination, and was confirmed with palpation during the surgery. Out of
the 25 cases, 7 patients were male and 18were female, with an average
age of 50.52 (SD11.5) years.
Surgical technique: In all of the cases, the same
standardized surgical approach was applied and performed by the same
senior surgeon. After an endaural approach, the posterior TM flap was
lifted, and the cause of failure was verified by the palpation of the
ossicular chain andwith microscopic examination. According to the
intratympanic findings, prosthesis replacement orrepositioning was
performed, and adhesions were removed. Infive cases, malleovestibulopexy
wasperformed. Stapedectomy was performed in one case only, otherwise,
small fenestra technique was preferred.
The prosthesis loop was bridged with a small connective tissue to
prevent the slipping and necrosis of the long process. The TM flap was
restored, meatal incisions were overlaid with sterile silicone sheets,
and the ear canal was stuffed with ofloxacin-impregnated absorbable
hemostatic gelatin sponge (Spongostan) pieces. The incision was closed
with sutures.
The length of the applied prosthesis was 4.5mm in 56%, 5mm in 8%,and
6mm in 20% of the cases, with a diameter of 0.4mm in 32% and 0.6mm in
52%. The majority (52%) of the applied pistons were Schuknecht
fluoroplastic, stainless, slim shaft wire pistons (Gyrus Acmi, USA),
Richards Platinum Fluoroplastic Pistons (Olympus, Japan) were applied in
32% of the cases. In the remaining surgeries the originalpistons were
used(16%).