Endoscopic revision stapes surgery: surgical findings and outcomes

• DOI: 10.1007/s00405-019-05280-4
• Publication Date: 2019-01-11T12:12:21Z
• Authors: Ignacio Javier Fe...; Domenico Villari; Cecilia Botti; Livio Presutti
• Keywords: Adult; Male; Reoperation; Adolescent; Endoscopic ear surgery; Endoscopic stapes surgery; Revision stapedotomy; Revision stapes surgery; Stapes surgery; Adolescent; Adult; Aged; Ear, Middle; Endoscopy; Feasibility Studies; Female; Hearing Tests; Humans; Intraoperative Care; Male; Medical Illustration; Middle Aged; Reoperation; Retrospective Studies; Stapes Surgery; Treatment Outcome; Videotape Recording; Young Adult; Hearing; Ossicular Prosthesis; Ear, Middle; Stapes Surgery; 03 medical and health sciences; 0302 clinical medicine; Hearing; Medical Illustration; Humans; Aged; Retrospective Studies; Intraoperative Care; Hearing Tests; Videotape Recording; Endoscopy; Middle Aged; Ossicular Prosthesis; Treatment Outcome; Feasibility Studies; Female; Endoscopic ear surgery; Endoscopic stapes surgery; Revision stapedotomy; Revision stapes surgery; Stapes surgery

Hearing results in revision stapes surgery are largely dependent on the cause of failure, and an appropriate intraoperative diagnosis is crucial for a good outcome. The endoscope allows a detailed exploration of the middle ear cavity and is particularly suitable for the intraoperative assessment of the cause of failure of previous stapes surgery. The present study analyzes the intraoperative findings and outcomes of patients undergoing revision stapes surgery through the endoscopic transcanal approach.Surgical videos and charts of patients undergoing endoscopic revision stapes surgery from 2008 to 2017 were reviewed retrospectively. Intraoperative findings, difficulties encountered during the surgery and hearing outcomes were evaluated. The feasibility of each surgical step with the totally endoscopic approach or the need for bimanual manipulation was assessed as well.Thirty-four patients were included in the study. The endoscopic transcanal approach allowed a detailed exploration of the middle ear cavity and an accurate intraoperative diagnosis and management of the different causes of failure of the previous surgery. 89.8% of patients achieved an air-bone gap for the PTA ≤ 20 dBHL and 68.5% a closure of the air-bone gap.The present study showed that totally endoscopic revision stapes surgery is a feasible, safe and effective procedure. The transcanal endoscopic approach allowed an accurate intraoperative diagnosis without the need for an endaural or retroauricular approach, with the possibility to manage all the possible intraoperative scenarios. A larger series with a longer follow-up is needed to validate the results.