Few centres have much experience of revision stapes surgery, so it was interesting to read about the findings of this Turkish centre with regards to the causes and outcomes for revision otosclerosis surgery over a 16-year period. A total of 2188 stapedotomy operations were carried out during this period. Out of this, revision surgery was performed in 108 cases. However, three patients were excluded from the study due to insufficient data. The authors therefore carried out a retrospective review of 105 patients who underwent revision stapes surgery for hearing loss despite initial stapes surgery. The revision rate of surgery was 2.75% in the authors’ institution. The mean preoperative hearing threshold of the patients was 57.1dB and the mean air-bone gap (ABG) was 27.4dB, whilst the postoperative averages were 49.7dB and 19.2dB respectively (p<0.05). The authors achieved an ABG <10dB in 51.4% of cases. In 60.9% of cases the reason for revision surgery was due to the prosthesis. Dislocation of the prosthesis was found in 41.9% of cases, and the authors suggest that reasons for this include a large stapedotomy, selection of a short prosthesis, or fibrous bands and adhesions. The authors found that 17.1% of their revision cases were due to necrosis of the long process of the incus. Based on these findings, the authors have suggested use of a fluoroplastic piston, fatty tissue to seal the stapedotomy, and use of the reverse stapedotomy technique. This study provides useful insight into the success rate of revision stapes surgery and possible reasons for failure of primary stapes surgery.

Sixteen years of experience with otosclerosis revision surgery: report of 105 cases.
Duzenli U, Catli T, Gur H, et al.
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Sunil Sharma

Alder Hey Children's Hospital, UK.

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