Stapes surgery for otosclerosis has a high success and low complication rate but, over a period of time, good results can deteriorate, requiring revision surgery. In this study, the authors have focused on patients’ demographic data as predictive factors for requiring revision surgery in relation to other perspectives, such as surgical technique and types of prosthesis used. In this retrospective study, there were 143 patients not requiring revision surgery after two years, comprising the ‘control’ group, and 145 requiring revision surgery in the same postoperative period, comprising the ‘revision’ group. It was found that there were more patients in the ‘revision’ group who had diabetes, dyslipidaemia, high blood pressure and active smoking habits. Poor vascularisation due to diabetes and smoking was considered a factor. Use of Teflon piston seemed to be more associated with lysis of long process of incus. No significant difference was found between various surgical techniques used such as stapedectomy or stapedotomy, use of laser or manual procedure. Patients operated on at younger age required revision surgery more than those operated on at an older age, presumably due to longer lifetime of younger patients. In terms of residual air-bone gap, results were poorer after revision surgery compared to primary surgery. The authors emphasise holistic evaluation of patients undergoing stapes surgery and the need for counselling in a multidisciplinary setting. The study opens a new and useful perspective to surgery for otosclerosis.
Patient-related factors that require revision surgery for otosclerosis
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