Stapedectomy in congenital stapes fixation: Are hearing outcomes poorer?

Abstract

Objectives: To evaluate outcomes of stapedectomy surgery for congenital stapes fixation. Methods: The charts of 463 stapedectomies performed by one surgeon from 1996–2003 were reviewed. Patients with a history of childhood hearing loss and operative findings consistent with congenital fixation of the stapes were included. Patients with a history of trauma or chronic otitis media and those with otosclerosis were excluded. Thirty-six patients underwent stapedectomy for congenital fixation. Revision cases and those with inadequate bone conduction threshold data were excluded. Inclusion criteria were met for 22 patients. Operative findings and hearing outcomes were analyzed. Results: The study group comprised 22 stapedectomies. Closure of the air-bone gap to less than 10 dB was achieved in 54.5% of the cases and 77.1% had closure within 20 dB. A gap of more than 30 dB remained in 13.6% of the cases. The rate of sensorineural hearing loss was 13.6%. In addition to an excluded case that was not reconstructed due to facial nerve position, 3 of the included patients were found to have a dehiscent facial nerve at surgery. Abnormalities of the malleus or incus were not found in any of the included patients. Conclusions: We recently reviewed our stapedectomy results in otosclerosis patients and found closure to within 10 dB to be 86%. This difference in results likely reflects subtle anatomic variations in the congenital group that affect the mobility of the prosthesis. Despite the difference in results, stapedectomy for congenital fixation remains an effective technique to achieve significant hearing improvement in the majority of patients.