Les réinterventions dans la chirurgie de l'otospongiose: à propos de 73 cas

Abstract

The aim of this study was to determine causes and evaluate results of revision stapedectomy. Retrospective review of 73 revision stapedectomies. Revision stapedectomies were performed in two tertiary otolaryngology departments (Fondation Adolphe de Rothschild, Paris, France, and Cliniques universitaires Saint-Luc, Bruxelles, Belgium). Patients characteristics, indications for revision, intraoperative findings, and hearing results were noted. Hearing results were reported as recommended by the American Academy of Otolaryngology-Head and Neck Surgery. We also reported hearing results with and without the use of a laser. Conductive hearing loss was the main indication for revision (78%). Mean intraoperative findings included prosthesis malfunction (50%), fibrous adhesions (32.8%), incus necrosis (8.5%), and otosclerotic regrowth (7%). When revision was performed because of cochleovestibular complication, middle ear exploration revealed three findings: oval window granuloma (30.7%), perilymphatic fistula (30.7%), and a too long prosthesis (23%). Postoperative air-bone gap (ABG) was closed to less than 10 dB in 51.5% of cases and to less than 20 dB in 68.7% of cases, with 9% of sensorineural hearing loss (not exceeding 15 dB in 80% of cases). The use of an argon laser in 14 patients (19%) showed slightly better hearing results (postoperative ABG < 10 dB in 61.5% of cases and < 20 dB in 77% of cases), but this difference was not statistically significant compared with patients operated on without the use of a laser. The results of this series are comparable with previously published studies. Revision stapes surgery is not as successful as primary stapedectomy, but good gap closure can be expected in two-thirds of cases with an experienced surgeon.