OBJECTIVE: The aim of this study was to evaluate the causes, the diagnosis, the treatment and the results obtained by revision surgery, in cases of stapedectomy failures. MATERIALS AND METHODS: Retrospective study of 50 recent cases operated on between January 1997 and December 2001. DIAGNOSIS OF THE FAILURE: All reoperated @entity1 had clinical and audiological assessment; CT scan with virtual endoscopy. RESULTS: The mean time of onset of failure was 23 months. The mean preoperative air bone gap was 25.5 dB. Otoscopy revealed a retraction pocket caused by poor eustachian tube function in 9 cases. CT scan proved to be very effective at differentiating the cause of the failure. OPERATIVE FINDINGS: In 11 cases the prosthesis was too short, in 8 cases the prosthesis had migrated out of the hole of stapedotomy and in 6 cases the piston was fixed in the stapedotomy hole. A partial or complete lysis of the long process of the incus was frequently associated, but in 9 cases it was the only cause of the failure. In all the cases when the piston was displaced, the stapedotomy was found to be covered by a thin mucous membrane, avoiding labyrinthine fistula. In 3 cases, the failure was due to recurrent @entity8719 . In 5 cases the failure was due to a @entity154 at the level of the oval window niche, 2 cases of failure were due to a @entity3947 . In 5 cases @entity82 was found between the incus and the mucosa of the promontory. In one case a reparative @entity738 was found at the level of the oval window. TREATMENT: In cases of partial lysis of the long process of the incus, a new prosthesis was placed in a 0.4 mm diameter stapedotomy, performed using a KTP laser. A 0.4 mm diameter piston was extended 0.2 mm below stapedotomy to avoid a new extrusion. Indeed some prosthesis extrusion could be due to increased movements of the ossicular chain in cases of @entity409 . In cases of complete lysis of the long process of the incus, or in cases of a very short long process of the incus, a piston was put in the stapedotomy and attached to the malleus manubrium. The results of revision stapedotomy were favorable in the absence of associated fibrous tissue adhesion or local @entity600 . The air bone gap was found to be less than 10 dB in 40 cases and between 10 and 20 dB in 8 cases. An impairment of the air bone gap was found in 2 cases. No case of bone conduction impairment was found in this series.

[Failure of regain full function after surgery for XXXX : causes, diagnosis and treatment].

@entity1 :: ('9606', 'Species') :: ['patients'] @entity154 :: ('MESH:D000013', 'Disease') :: ['local anomaly'] @entity82 :: ('MESH:D005355', 'Disease') :: ['fibrous adhesion'] @entity738 :: ('MESH:D006099', 'Disease') :: ['granuloma'] @entity8719 :: ('MESH:D010040', 'Disease') :: ['otosclerosis'] @entity409 :: ('MESH:D008107', 'Disease') :: ['eustachian tube dysfunction'] @entity3947 :: ('MESH:D000844', 'Disease') :: ['malleus ankylosis'] @entity600 :: ('MESH:D000014', 'Disease') :: ['malformation']
@entity8719 :: (MESH:D010040,Disease) :: ['otosclerosis']
