Hearing Outcomes after Revision Stapedectomy Managed with Total Ossicular Reconstruction Prostheses

Abstract

Objectives: (1) Describe the use of total ossicular reconstruction prostheses (TORP) during revision stapedectomy in the setting of advanced incus erosion. (2) Analyze the short- and medium-term audiometric results of TORP for revision stapedectomy. Methods: A retrospective case review at a tertiary neurotological referral center was conducted of nineteen cases of revision stapedectomy where TORP reconstruction was performed due to advanced incus erosion. Pre- and postoperative bone conduction (BC-PTA) and air conduction (AC-PTA) pure tone averages (0.5, 1, 2, 3 kHz) including high tone bone conduction (1, 2, 3 kHz), air-bone gap (ABG), and speech discrimination scores (SDS) were measured. Short-term (3 weeks) and medium-term (median, 12 months) hearing outcomes were measured. Results: Among 19 ears undergoing revision stapedectomy managed with TORP reconstruction, the average number of previous revision attempts was 1.2 (SD, 2; range, 1-6). The preoperative BC-PTA was 32.1 dB preoperatively while the preoperative AC-PTA was 65.3 dB. The mean postoperative ABG significantly decreased to 16.6 dB (SD, 13.68; range, −2.5 to 46.3 dB, P < .003) with mean follow-up of 15 months (SD, 18.8; range, 0.75-54 months). A nonsignificant mean high tone BC-PTA decrement of 3.8 dB (SD = 5.9, range −8.33 to 18.33 dB, P = .427) was observed including one ear with no responses postoperatively. No further revisions were noted in follow-up. Conclusions: Total ossicular reconstruction in the setting of previous revision stapedectomy with limited incudovestibular reconstructive options may lead to favorable hearing outcomes but carries an increased risk of sensorineural hearing loss.