Long-Term Impact of Incus Necrosis on Revision Stapes Surgery

OBJECTIVE: To determine the effect of incus necrosis on the success of revision stapes surgery. STUDY DESIGN: Retrospective chart review. PATIENTS: Two hundred twenty-two ears in 174 consecutive patients who had revision stapes surgery from 1987 to 2007. INTERVENTION: The status of the incus was determined at revision surgery in all 222 ears. There were 68 ears with no incus damage and 154 ears with mild to severe incus necrosis. Based on surgical judgment, 58 ears had a reconstruction from the malleus to an oval window fenestra, and 96 ears had a reconstruction from the damaged incus. MAIN OUTCOME MEASURES: American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines, including 4-frequency pure-tone average, success rate (gap <10 dB), and Kaplan-Meier product-survival procedure. RESULTS: When success was defined as an air-bone gap of 10 dB or less at 1 year, patients with a reconstruction to a normal incus, necrotic incus, or malleus had similar success rates ranging from 47 to 54%. Success over time was significantly poorer for patients with a reconstruction to a necrotic incus (median failure at 30 mo) compared with reconstruction to a normal incus (144 mo) or malleus (75 mo; p < 0.05). Reconstruction to the malleus posed a greater risk of high-frequency hearing loss than reconstruction to the incus by an average of 2.3 dB. CONCLUSION: Incus necrosis bodes poorly for reconstruction from the incus. Reconstruction from the malleus provided a more stable long-term reconstruction but greater risk of surgical damage to the inner ear.