Outcomes of Stapedotomy With Heat-Crimped Prostheses.

BACKGROUND

Theoretical disadvantages are associated with the use of heat-crimped piston prostheses in stapedotomy. Loose crimping could result in prosthesis displacement or slippage. Alternatively, overly tight crimping may cause trauma to the incus with resultant necrosis.

OBJECTIVES

1) Analyze outcomes of patients undergoing stapedotomy with heat-activated piston-style prostheses, and 2) compare outcomes between prostheses made by different manufacturers.

STUDY

DESIGN

Retrospective.

SETTING

Vanderbilt Medical Center.

PATIENTS AND

METHODS

Cases undergoing stapedotomy between 2005 and 2016 were reviewed. Audiometric assessments were recorded in accordance with American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. Patients who lacked audiometric follow-up before 6 months or after 1 year were excluded.

INTERVENTION(S): Diagnostic, therapeutic, and rehabilitative.

MAIN OUTCOME MEASURE(S): Postoperative air-bone gap (ABG) and achievement of an ABG is less than or equal to 10 dB.

RESULTS

Three hundred fifty-eight patients met inclusion criteria. At short-term follow-up (<6 mo), the mean ABG was 11 ± 8 dB in the entire cohort; this did not differ based on manufacturer (p = 0.13). The majority of patients (63%) achieved an ABG less than or equal to 10 dB. At longer-term follow-up, the mean ABG was 9 ± 7 dB; again no differences were noted when comparing prosthesis manufacturer (p = 0.20). 70% of patients achieved an ABG less than or equal to 10 dB at longer-term follow-up. When comparing short- to long-term follow-up, ABG did not significantly change over time (p = 0.76). The overall revision rate was 1.9% (n = 7).

CONCLUSION

Favorable hearing outcomes are obtained both short- and long-term following stapedotomy and placement of heat-crimped piston prostheses. Both prosthesis groups appear stable in the middle ear environment long-term, as evidenced by a 1.9% revision rate among them.