Malleostapedotomy in revision surgery for otosclerosis

Purpose: The purpose of this study was to analyze the results of malleostap edotomy and to compare them with those of a conventional incus stapedotomy in a series of 82 consecutive surgical revisions in otosclerotic patients. Materials and Methods: 82 consecutive revision stapes surgery cases over 5 years were evaluated. The preoperative and postoperative audiometric data o f 80 (97.5%) of the patients were obtained. Results: 71 of the patients underwent a functional revision procedure as ma lleostapedotomy (56, 79%) or as incus stapedotomy (15, 21%). The most commo n cause of failure of primary surgery was a displaced or malfunctioning pro sthesis (86.2%). Pathologic changes of the oval window were found in 80% of the cases. Problems of the incus were identified in 80% and abnormality of the malleus in 48.6% of the cases. The functional success rate of malleost apedotomy (Closure within 10 dB) was found to be higher than that of tradit ional incus stapedotomy (p < 0.05). Overclosure was seen in 12 patients (17 %) and a significant sensorineural hearing loss in 2 patients (3%). There w ere no dead cars in this series, The postoperative hearing results after fi rst revision surgery were better than those after multiple surgical procedu res (p < 0.05). Conclusions: Malleostapedotomy yields better functional hearing results tha n incus stapedotomy in revision surgery for otosclerosis. The detection of many malleus fixations was the result of the systematic exposure of the ant erior malleal process and ligament through an endaural approach with superi or canaloplasty.