Abstract
Statement of Problem. Stapedotomy is the treatment of choice for otosclerosis. Numerous techniques and prosthesis are available to perform this procedure. Success rates of surgery vary from 17% to 80%, and revision surgery carries an increased risk of complications as well as poorer hearing outcomes. Method of Study. Case report. Results. We report the first case of uncrimping of a SMart stapes prosthesis with no lateral displacement as a cause of late failure despite successful crimping and improvement in audiological outcomes after initial surgery. Conclusion. The SMart stapes prosthesis is widely used and has been shown to be safe and provide good hearing outcomes. Displacement of a stapes prosthesis is the commonest cause of failure. Our case shows that deterioration of hearing thresholds can occur from uncrimping of the prosthesis with no displacement. It is important to improve our understanding of stapedotomy failure as revision procedures are associated with poorer outcomes.
Highlights
Since Shea introduced stapedotomy in 1958 as standard treatment for otosclerosis, there have been a myriad of prostheses that have been developed [1]
The SMart prosthesis is marketed on the ability of its piston wire to self-fasten or crimp securely around the incus following the application of heat
There could well have been an inherent problem with the manufacturing of this individual prosthesis, whereby the ratio of titanium and nickel (55% versus 45%) deviated from the recommended ratio, leading to a prosthesis with poor shape memory that is liable to “uncrimp.” Another possibility was that the shape memory of the hook could have been lost if the alloy was exposed to excessive stress, but at no point during the procedure was this likely to have occurred as the prosthesis was heat-activated
Summary
Since Shea introduced stapedotomy in 1958 as standard treatment for otosclerosis, there have been a myriad of prostheses that have been developed [1]. The SMart stapes piston prosthesis (Gyrus-ENT; Bartlett, TN, USA) is a newer addition to the wide range of prostheses that are available. It is composed of a nitinol-based Shepard hook and a Telfon-based piston. The SMart prosthesis is marketed on the ability of its piston wire to self-fasten or crimp securely around the incus following the application of heat. We report a case of “uncrimping” with no lateral displacement of the SMart stapes prosthesis 3 years after successful application with deterioration of hearing thresholds. To our knowledge, this is the first reported case in the literature
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