Diagnostic findings in stapes revision surgery : A retrospective of 26 years

Abstract

Objective: The aim of the study is to obtain a detailed overview of the revision findings after stapes operations and to draw conclusions on a stapes prosthesis that can be recommended.Study Design: Retrospective case series.Setting: Tertiary otologic referral center.Methods: Approximately 12,000 middle ear operations within a period of 26 years were evaluated. The findings of the revisions were classified into surgeon related, prosthesis related, and other causes.Results: Three hundred forty-three stapes revisions were done. Many different prostheses were found: the most common were Schuknecht prostheses and Teflon platinum, gold, and titanium pistons. Polyethylene strut, Teflon wire pistons, Shea (Teflon) pistons, and other techniques, such as columella or malleovestibulopexy, were rarely found.There are specific findings correlating to certain prostheses: Schuknecht prostheses were too short in 50% of the revisions (surgeon related), Teflon platinum caused necrosis or arrosion of the long incudal process (prostheses related) in 69%, and gold caused reparative granuloma sometimes combined with necosis of the incus in 70% (prostheses related). There was no specific diagnostic finding with titanium pistons, neither surgeon nor material related.Conclusion: An analysis of revision findings over an extended observation period can enable middle-ear surgeons to improve their surgical techniques and to select the best suited prosthesis. Self-fabricated stapes prostheses (e.g., Schuknecht) do not conform to required quality standards and should not be used. GoPi, which is no longer available, and TPlPi showed prosthesis-related diagnostic findings. The titanium prostheses used by the authors have proven to be excellently compatible and can therefore be recommended as safe stapes prostheses.