The malleus to oval window revision stapedotomy: Efficacy and longitudinal study outcome.

OBJECTIVE To determine the longitudinal effectiveness of the malleus to oval window stapedotomy technique among patients undergoing revision surgery when the incus is unavailable. STUDY DESIGN Retrospective, case series. METHODS Charts of 15 patients who underwent 17 malleus attachment stapedotomies performed by a single surgeon from 2000 to 2015 were reviewed. Surgery was ambulatory, transcanal, with laser technique, and under local anesthesia. RESULTS Of 17 stapedotomies performed, there were nine first revisions, six second revisions, one third revision, and one fourth revision. There were no surgical complications. Mean preoperative air-bone gap (ABG) was 32.3 dB. Mean postoperative ABG at 6 months was 10.7 dB, and at last follow-up was 16.3 dB. Average length of follow-up was 36.5 months. At last follow-up, 100% of first revisions achieved ABG ≤ 20 dB (77.8% ≤ 10 dB), compared to 50% of second revisions with ABG ≤ 20 dB (none ≤ 10 dB), and 0% of third or fourth revisions with ABG ≤ 20 dB. Trend lines for second and third/fourth revisions showed a deterioration (widening) in postoperative ABG by 0.18 and 0.72 dB per month, respectively. The first-revision trend line, conversely, showed negligible change with time, demonstrating the superior durability of first revisions compared to subsequent surgeries. CONCLUSION The malleus to oval window stapedotomy technique is more effective and longer lasting in first-revision surgery compared to subsequent procedures. Standard or implantable amplification devices may be preferable for patients with multiple prior procedures. LEVEL OF EVIDENCE 4. Laryngoscope, 128:461-467, 2018.