Outcomes in Revision Stapes Surgery

Objectives To compare audiometric outcomes and complication rates between primary and revision stapes surgical cases. Study Design Retrospective cohort study. Setting Large single-institution database. Methods Data on 809 patients (including 170 revisions) undergoing primary and revision stapes surgery were reviewed, with Pearson chi-square and multivariable logistic regression analysis performed. Results Rates of postoperative air-bone gap (ABG) closure to <= 10 dB were significantly worse in the revision group (40.2% vs 61.8%, P < .001), as were those to <= 20 dB (78.1% vs 90.9%, P < .001). The bone conduction pure tone average worsened by >10 dB in 7.1% of primary cases and 13.1% of revisions (P = .016). The mean postoperative ABG for revision cases was significantly higher at 15.5 dB as compared with 11.0 dB for primaries (P < .001), despite a slightly higher preoperative ABG for primary cases (30.6 vs 28.24 dB, P = .010). In multivariate analysis, revision surgery had an odds ratio 0.41 (P < .001) in closing the ABG to <= 10 dB. Postoperative reparative granuloma (2.4% vs 0.2%, P = .001) and hydrops (1.8% vs 0.2%, P = .008) were higher in revision cases. Conclusions Revision stapes surgery was found to have less predictable and inferior results as compared with primary cases.