Revision Stapedectomy in a Female Patient with Inner Ear Malformation

Abstract

Objectives. We describe an unusual case of surgical management of congenital mixed hearing loss in a female patient with inner ear malformation. This report outlines the role of temporal bone imaging and previous surgical history in evaluating a patient's risk of perilymph gusher during stapes surgery. Methods. A 68-year-old female patient with a history of profound bilateral mixed hearing loss due to ossicular and cochlear malformation presented to our otology clinic. She had undergone multiple unsuccessful previous ear surgeries. Computed tomography revealed bilateral inner ear malformations. She elected to proceed with revision stapedectomy. Results. The patient received modest benefit to hearing, and no operative complications occurred. Conclusions. Although stapedectomy has been shown to improve hearing in patients with stapes fixation, there is risk of perilymph gusher in patients with inner ear abnormalities. Evaluation and counseling of the risk of gusher during stapes surgery should be done on a case-by-case basis.

Figure 1

Patient's pure-tone audiogram, revealing a profound mixed hearing loss bilaterally.

Figure 2

Axial noncontrast computed tomography of right temporal bone reveals incomplete separation of the right internal auditory canal from the basal turn of the cochlea (arrow) and an enlarged vestibule (asterisk).

Figure 3

Coronal noncontrast computed tomography of right temporal bone reveals the end of a previously placed stapes prosthesis (metallic object) abutting the second genu of the facial nerve (arrow), which is descending anterior to the promontory as evidenced by its location adjacent to the turns of the cochlea.