Revision Surgery for Reparative Granuloma Complicating Stapes Surgery for Otosclerosis: Report of 14 Cases

Objectives: To report a series of revision surgeries for reparative granuloma (RG) complicating stapes surgery

Materials and methods: We retrospectively reviewed 14 cases of revision surgery for sensorineural complication of primary stapes surgery for otosclerosis related to a RG.

Results: The primary procedure was a stapedotomy in 8 cases and a stapedectomy in 6. The onset of the sensorineural complication signs ranged between few hours to 12 days postoperatively. All 14 patients exhibited dizziness and vertigo, associated to a sensorineural hearing loss in 13 (total deafness in 4 and significant bone conduction worsening in 9). In all 14 cases, postoperative CT scan showed a middle ear opacity surrounded the piston. The decision for revision surgery was taken after an ineffective trial of systemic steroids and antibiotics. The revision procedure systematically consisted in: removal of the prosthesis and the RG and instillation of steroids in the middle ear. A new piston was inserted in 13 cases. Few days after revision, all the patients reported improvement of dizziness and vertigo (complete in 9 and significant in 5). Hearing outcome was not predictable. In the 4 patients with total deafness, 2 did not change while 2 improved. In the 9 patients with significant BC thresholds worsening, 3 progressed to total deafness, 4 remained stable and 2 recovered. At last evaluation of the 13 patients with sensorineural hearing loss before revision, we observed 5 patients with total deafness, 7 with serviceable hearing allowing conventional hearing aid rehabilitation and 1 significant improvement.

Conclusion: RG is a rare but severe sensorineural complication of stapes surgery. Surgical revision after failure of medical treatment is a good option to alleviate vertigo and may sometimes resuscitate serviceable hearing.