Stapedectomy revision of the wire-Gelfoam prosthesis.

Revision procedures in which a vein graft with a Robinson stapes prosthesis was used are reviewed in 100 patients. In all cases a wire-Gelfoam stapes prosthesis had been used initially. The surgical findings were prosthesis malfunction, 48%; eroded incus, 16%; negative findings, 14%; footplate not removed, 11%; oval window fistula, 7%; and incus problems, 4%. Postoperatively, hearing in 70.5% of the patients with conductive hearing loss was within 10 dB and 84.5% within 20 dB. The high success rate is affected by the fact that patients with conductive hearing loss were separated from those with sensorineural hearing loss, a piston prosthesis on tissue was used in the revision surgical procedure, and patients with otosclerosis regrowth did not undergo revision. Surgical directives to minimize hearing loss included use of a tissue seal over the oval window; not reopening the oval window; monitoring the patient for dizziness; performing audiometric tests during surgery; leaving the wire in place in certain cases; and not revising the prosthesis in patients with otosclerosis regrowth.