Ethical approval
This research was approved by ’[removed for blind peer review].For this type of study, formal consent is not required.
Patients: A retrospective case series study of 25revision stapedotomy was performed. The surgeries were carried out between 2013-2020,at the Department of Oto-Rhino-Laryngology, Head and Neck Surgery [removed for blind review]. The indication for revision was 10 dB or higher persistent ABG-PTA. The presumed preoperative clinical diagnosis of stapes fixation before primary intervention was made by PTA testing, tympanometry, stapedius reflex, and physical examination, and was confirmed with palpation during the surgery. Out of the 25 cases, 7 patients were male and 18were female, with an average age of 50.52 (SD11.5) years.
Surgical technique: In all of the cases, the same standardized surgical approach was applied and performed by the same senior surgeon. After an endaural approach, the posterior TM flap was lifted, and the cause of failure was verified by the palpation of the ossicular chain andwith microscopic examination. According to the intratympanic findings, prosthesis replacement orrepositioning was performed, and adhesions were removed. Infive cases, malleovestibulopexy wasperformed. Stapedectomy was performed in one case only, otherwise, small fenestra technique was preferred.
The prosthesis loop was bridged with a small connective tissue to prevent the slipping and necrosis of the long process. The TM flap was restored, meatal incisions were overlaid with sterile silicone sheets, and the ear canal was stuffed with ofloxacin-impregnated absorbable hemostatic gelatin sponge (Spongostan) pieces. The incision was closed with sutures.
The length of the applied prosthesis was 4.5mm in 56%, 5mm in 8%,and 6mm in 20% of the cases, with a diameter of 0.4mm in 32% and 0.6mm in 52%. The majority (52%) of the applied pistons were Schuknecht fluoroplastic, stainless, slim shaft wire pistons (Gyrus Acmi, USA), Richards Platinum Fluoroplastic Pistons (Olympus, Japan) were applied in 32% of the cases. In the remaining surgeries the originalpistons were used(16%).