European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 3, pp 703–710 | Cite as

Endoscopic revision stapes surgery: surgical findings and outcomes

  • Ignacio Javier Fernandez
  • Domenico Villari
  • Cecilia BottiEmail author
  • Livio Presutti



Hearing results in revision stapes surgery are largely dependent on the cause of failure, and an appropriate intraoperative diagnosis is crucial for a good outcome. The endoscope allows a detailed exploration of the middle ear cavity and is particularly suitable for the intraoperative assessment of the cause of failure of previous stapes surgery. The present study analyzes the intraoperative findings and outcomes of patients undergoing revision stapes surgery through the endoscopic transcanal approach.


Surgical videos and charts of patients undergoing endoscopic revision stapes surgery from 2008 to 2017 were reviewed retrospectively. Intraoperative findings, difficulties encountered during the surgery and hearing outcomes were evaluated. The feasibility of each surgical step with the totally endoscopic approach or the need for bimanual manipulation was assessed as well.


Thirty-four patients were included in the study. The endoscopic transcanal approach allowed a detailed exploration of the middle ear cavity and an accurate intraoperative diagnosis and management of the different causes of failure of the previous surgery. 89.8% of patients achieved an air-bone gap for the PTA ≤ 20 dBHL and 68.5% a closure of the air-bone gap.


The present study showed that totally endoscopic revision stapes surgery is a feasible, safe and effective procedure. The transcanal endoscopic approach allowed an accurate intraoperative diagnosis without the need for an endaural or retroauricular approach, with the possibility to manage all the possible intraoperative scenarios. A larger series with a longer follow-up is needed to validate the results.


Endoscopic ear surgery Revision stapes surgery Revision stapedotomy Endoscopic stapes surgery Stapes surgery 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MPG 68778 KB)


  1. 1.
    Battista RA, Wiet RJ, Joy J (2006) Revision stapedectomy. Otolaryngol Clin N Am 39(4):677–697. (Review) CrossRefGoogle Scholar
  2. 2.
    Durko M, Kaczmarczyk D, Durko T (2007) Revision stapes surgery: retrospective analysis of surgical findings in a series of 21 otosclerosis patients. Adv Otorhinolaryngol 65:273–277PubMedGoogle Scholar
  3. 3.
    Kanona H, Bhutta MF, Lavy J (2017) Our approach to revision stapes surgery and the outcomes from 49 procedures at a UK tertiary centre. Clin Otolaryngol 42(4):931–935CrossRefPubMedGoogle Scholar
  4. 4.
    Pedersen CB (1994) Revision surgery in otosclerosis—operative findings in 186 patients. Clin Otolaryngol Allied Sci 19(5):446–450CrossRefPubMedGoogle Scholar
  5. 5.
    Han WW, Incesulu A, McKenna MJ et al (1997) Revision stapedectomy: intraoperative findings, results, and review of the literature. Laryngoscope 107(9):1185–1192. (Review) CrossRefPubMedGoogle Scholar
  6. 6.
    Hammerschlag PE, Fishman A, Scheer AA (1998). A review of 308 cases of revision stapedectomy. Laryngoscope 108(12):1794–1800CrossRefPubMedGoogle Scholar
  7. 7.
    De la Cruz A, Fayad JN (2000) Revision stapedectomy. Otolarygology head and neck surgery. Otolaryngol Head Neck Surg 123(6):728–732CrossRefGoogle Scholar
  8. 8.
    Lippy WH, Battista RA, Berenholz L et al (2003) Twenty-year review of revision stapedectomy. Otol Neurotol 24(4):560–566CrossRefPubMedGoogle Scholar
  9. 9.
    Gros A, Vatovec J, Zargi M, Jenko K (2005) Success rate in revision stapes surgery for otosclerosis. Otol Neurotol 26(6):1143–1148CrossRefPubMedGoogle Scholar
  10. 10.
    Schmid P, Häusler R (2009) Revision stapedectomy: an analysis of 201 operations. Otol Neurotol 30(8):1092–1100. CrossRefPubMedGoogle Scholar
  11. 11.
    Vincent R, Rovers M, Zingade N, Oates J, Sperling N, Devèze A, Grolman W (2010) Revision stapedotomy: operative findings and hearing results. A prospective study of 652 cases from the otology–neurotology database. Otol Neurotol 31(6):875–882CrossRefPubMedGoogle Scholar
  12. 12.
    Bernardeschi D, Canu G, De Seta D, Russo FY, Ferrary E, Mosnier I, Sterkers O (2018) Revision stapes surgery: a review of 102 cases. Clin Otolaryngol. PubMedGoogle Scholar
  13. 13.
    McGee TM (1981) The loose wire syndrome. Laryngoscope 91(9 Pt 1):1478–1483PubMedGoogle Scholar
  14. 14.
    Lippy WH, Berenholz LP (2010) The long prosthesis syndrome. Otol Neurotol 31(3):548–549CrossRefPubMedGoogle Scholar
  15. 15.
    Gurgel RK, Jackler RK, Dobie RA, Popelka GR (2012) A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 147(5):803–807CrossRefPubMedGoogle Scholar
  16. 16.
    Shea JJ (1958) Fenestration of the oval window. Ann Otol Rhinol Laryngol 67:932–951CrossRefPubMedGoogle Scholar
  17. 17.
    Shea JJ, Sanabira F, Smyth GDL (1962) Teflon piston operation for otosclerosis. Arch Otolaryngol 76:516–521CrossRefGoogle Scholar
  18. 18.
    Wegner I, Vincent R, Derks LSM, Rauh SP, Heymans MW, Stegeman I, Grolman W (2018) An internally validated prognostic model for success in revision stapes surgery for otosclerosis. Laryngoscope. PubMedGoogle Scholar
  19. 19.
    Glasscock ME, Storper IS, Haynes DS et al (1995) Twenty-five years of experience with stapedectomy. Laryngoscope 105(9 Pt 1):899–904CrossRefPubMedGoogle Scholar
  20. 20.
    Marchioni D, Molteni G, Presutti L (2011) Endoscopic anatomy of the middle ear. Indian J Otolaryngol Head Neck Surg 63(2):101–113CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Marchioni D, Soloperto D, Villari D et al (2016) Stapes malformations: the contribute of the endoscopy for diagnosis and surgery. Eur Arch Otorhinolaryngol 273(7):1723–1729CrossRefPubMedGoogle Scholar
  22. 22.
    Nogueira JF, Mattioli F, Presutti L et al (2013) Endoscopic anatomy of the retrotympanum. Otolaryngol Clin N Am 46(2):179–188CrossRefGoogle Scholar
  23. 23.
    Marchioni D, Piccinini A, Alicandri-Ciufelli M et al (2013) Endoscopic anatomy and ventilation of the epitympanum. Otolaryngol Clin N Am 46(2):165–178CrossRefGoogle Scholar
  24. 24.
    Bonali M, Anschuetz L, Fermi M et al (2017 May) The variants of the retro- and hypotympanum: an endoscopic anatomical study. Eur Arch Otorhinolaryngol 274(5):2141–2148CrossRefPubMedGoogle Scholar
  25. 25.
    Fisch U, Acar GO, Huber AM (2001) Malleostapedotomy in revision surgery for otosclerosis. Otol neurotol 22:776–785CrossRefPubMedGoogle Scholar
  26. 26.
    Nandapalan V, Pollan A, Langner A et al (2002) The anterior and superior malleal ligaments in otosclerosis. Otol Neurotol 23:854–861CrossRefPubMedGoogle Scholar
  27. 27.
    Lesisnsky SG (2002) Causes of conductive hearing loss after stapedectomy or stapedotomy: a prospective study of 279 consecutive surgical revisions. Otol Neurotol 23(4):281–288CrossRefGoogle Scholar
  28. 28.
    Bernardeschi D, Lahlou G, De Seta D et al (2018) O. 3D endoscopic ear surgery: a clinical pilot study. Eur Arch Otorhinolaryngol 275(2):379–384CrossRefPubMedGoogle Scholar
  29. 29.
    Chen CK, Hsieh LC, Hsu TH (2018) Novel three-dimensional image system for endoscopic ear surgery. Eur Arch Otorhinolaryngol 275(12):2933–2939CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology, Head and Neck SurgeryUniversity Hospital of ModenaModenaItaly

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