Local antibiotic therapy to prevent cochlear hearing loss by surgery of the stapes footplate in tympanosclerosis.

Background: Mobilising the stapes via the removal of the tympanosclerotic p laques from the oval window niche (effodation) and stapedectomy or malleove stibulopexy are the different procedures generally available for the surgic al therapy of stapes fixation due to tympanosclerosis. These techniques bea r a significant risk of sensory hearing loss. Here we analyse our results u sing the mobilisation technique together with locally applied antibiotics. Patients: Nineteen ears in seventeen patients with tympanosclerosis involvi ng the stapes and its footplate which underwent stapes mobilisation between 1991 and 1999 have been investigated retrospectively. According to the lit erature this operation has a high risk of cochlear hearing loss. To reduce this risk, azlocillin was instilled locally during removal of tympanosclero tic plaques. Results: Different operation techniques have been used: classi c type III with placement of a cartilage disc on the head of the stapes (4) , interposition of the incus (3), interposition of the head of malleus (1), interposition of a ceramic-PORP (6) and cartilage columella in cases of si gnificant stapes footplate erosion (3). In two operations the chain was int act and no reconstruction was necessary. Pure-tone-audiometry showed no sig nificant decrease of bone-conduction thresholds. Preoperatively 4 (21.1%) e ars had an average air-bone-gap less than or equal to 30 dB, while postoper atively 15 (78.9%) ears had this level of hearing. Conclusions: Until the e xact causes of the loss of hearing after mobilisation or stapedectomy in ca ses of tympanosclerosis are known, the local administration of antibiotics is certainly recommended, bearing in mind the initial hypothesis that infec tion may be jointly responsible for cochlear hearing loss on mobilisation o r stapedectomy in cases of tympanosclerosis.