AOS029 - Impact of Modern Surgical Techniques on Rates of Sensorineural Hearing Loss and Revision Surgery after Stapedotomy
Saturday, April 30, 2022
9:14 AM – 9:21 AM CT
Location: Landmark A
Nabil F. Darwich, MD, PhD
Alexandra E. Quimby, MD, MPH
Tiffany P. Hwa, MD
Stephen J. Eliades, MD, PhD
Jason A. Brant, MD
Douglas C. Bigelow, MD
Michael J. Ruckenstein, MD, MSc
PGY-I University of Pennsylvania Hospital System Philadelphia, Pennsylvania
Objective: Historically, stapedectomy complication rates are quoted at 1% for profound postoperative sensorineural hearing loss (SNHL), 5-6% for non-profound SNHL, and 5% for revision surgery. We sought to reassess the rates of these and other common post-operative complications in our experience using modern surgical technique.
Study Design: Retrospective case series.
Setting: Single academic tertiary referral center.
Patients: Adults (> 18 years) who have undergone stapedotomy from 2013-2020.
Interventions: Stapedotomy.
Main Outcome Measures: Rates of post-operative profound SNHL, dizziness, tinnitus, and dysgeusia; successful airbone-gap closure; and revision rates.
Results: 468 stapedotomies performed in 402 patients by 4 surgeons were reviewed. Mean age was 49.85 years. The average preoperative air-bone gap was 31.60 dB. In 366 operations (78.20%), the patient experienced closure of the airbone gap within 10 dB, and in a further 74 (15.81%) there was closure to between 10-20 dB. Air pure tone audiometry scores improved by an average of 25.63 dB after surgery. Rates of postoperative dizziness, tinnitus, and dysgeusia were 6.20%, 3.63%, and 7.26%, respectively. There were 2 cases (0.43%) of postoperative profound SHNL and no nonprofound SNHL. There were 54 (11.72%) revision stapedotomies; however, in 20 of these (37.03%), the original stapedotomy was performed over 20 years ago. The revision rate for stapedotomies performed at our institution within the past 20 years was 3.63% (17 revision surgeries), completed within an average of 14.35 months from initial surgery.
Conclusions: Rates of post-operative SNHL and revision surgery following stapedotomy performed using modern technique are substantially lower than those commonly cited to patients based on classic techniques and historical data.
*Professional Practice Gap & Educational Need: Complication and success rates of stapedotomy cited to patients in preoperative counselling are in many instances based on historical data that does not take into account modern surgical technique.
*Learning Objective: Gain an updated understanding of the risks of stapedotomy in the modern era in order to better inform discussions with patients surrounding surgery.
*Desired Result: At the conclusion of this presentation, the participants should be able to recognize the rates of hearing loss and revision surgery after stapedotomy using modern surgical techniques compared to historical techniques. Participants will also be able to discuss surgical outcomes of modern stapedotomy.
*Level of Evidence: V
*Indicate IRB or IACUC: University of Pennsylvania, IRB exempt.