Pitfalls and Complications of Stapedectomy: A Prospective Study

Introduction: Stapedectomy is now one of the most popular and common surgeries done worldwide. Otosclerosis remains the most common single cause of conducting hearing loss in adult population. Females are more frequently affected than males with an approximate 2:1 ratio. Materials and Methods: This study consists of 94 patients who underwent stapedectomy for otosclerosis. This study was conducted at Government Theni Medical College Hospital, Theni, during the period of 3-year (2013-2016). Patients were evaluated and operated. The various anatomical variations, diagnostic dilemmas, intraoperative complications, its management and follow-up were done systematically. Results: Age of patients included in this study ranged from 14 to 58 years. Youngest patient was a 14-year-old girl. Surgery was done commonly in the age group between 31 and 40 years. Out of 94 patients, 46 (48.9%) were males and 48 (51.1%) were females. The family history of otosclerosis was noted in 48 patients (51.1%). Positive family history in females was about 56.3%, and positive family history in males was 43.7%.The most common symptom was hard of hearing followed by Paracusis willisi and tinnitus. In this study, 50% of the patients initially had noticed onset of conductive hearing loss during 2nd pregnancy and also aggravation of hearing loss during subsequent pregnancies. Bilateral otosclerosis was commonly encountered than unilateral involvement. The ratio was found to be higher in females. In cases of bilateral equal conductive hearing loss weber test was done to select the ear for surgery. In this study, 52% of patients had air-bone gap between 41 and 60 dB. Conclusion: The common problems encountered during stapedectomy are (1) excessive posterosuperior overhang, (2) narrow external auditory canal, and (3) narrow oval window niche. Surgical skills, tissue respect, experience, and aseptic surgical technique are essential to perform stapedectomy with least complications. Adequate postoperative care and proper instruction of the patient are mandatory for a good hearing result.