Revision Stapedectomy in a Female Patient with Inner Ear Malformation.

Tirth R Patel,Aaron C Moberly

doi:10.1155/2016/8520703

Tirth R Patel, Aaron C Moberly

Open Access

https://doi.org/10.1155/2016/8520703

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Abstract

Objectives. We describe an unusual case of surgical management of congenital mixed hearing loss in a female patient with inner ear malformation. This report outlines the role of temporal bone imaging and previous surgical history in evaluating a patient's risk of perilymph gusher during stapes surgery. Methods. A 68-year-old female patient with a history of profound bilateral mixed hearing loss due to ossicular and cochlear malformation presented to our otology clinic. She had undergone multiple unsuccessful previous ear surgeries. Computed tomography revealed bilateral inner ear malformations. She elected to proceed with revision stapedectomy. Results. The patient received modest benefit to hearing, and no operative complications occurred. Conclusions. Although stapedectomy has been shown to improve hearing in patients with stapes fixation, there is risk of perilymph gusher in patients with inner ear abnormalities. Evaluation and counseling of the risk of gusher during stapes surgery should be done on a case-by-case basis.

Highlights

Stapes fixation is a relatively common cause of conductive hearing loss, but it rarely presents with concomitant inner ear malformation, comprising a special challenge for the otologist
The patient presented in this report was likely diagnosed with congenital stapes fixation as a child and had undergone several stapedectomy attempts in the right ear to correct it
Congenital stapes fixation presents with a conductive hearing loss early in childhood. Juvenile otosclerosis is another entity that may cause a progressive fixation of the stapes, leading to a conductive hearing loss in the pediatric patient

Summary

Objectives

We describe an unusual case of surgical management of congenital mixed hearing loss in a female patient with inner ear malformation. This report outlines the role of temporal bone imaging and previous surgical history in evaluating a patient’s risk of perilymph gusher during stapes surgery. A 68-year-old female patient with a history of profound bilateral mixed hearing loss due to ossicular and cochlear malformation presented to our otology clinic. She had undergone multiple unsuccessful previous ear surgeries. Computed tomography revealed bilateral inner ear malformations She elected to proceed with revision stapedectomy. Stapedectomy has been shown to improve hearing in patients with stapes fixation, there is risk of perilymph gusher in patients with inner ear abnormalities. Evaluation and counseling of the risk of gusher during stapes surgery should be done on a case-by-case basis

Introduction

Case Presentation

Discussion