Bilateral Stapedectomy: Association of Intraoperative Findings between Ears and Impact on Second Ear Outcome

Aim: To review a single institution's experience with bilateral stapedectomy to define any association between the surgical findings between ears and assess the impact of these findings on the second ear audiometric outcome.

Methods: Retrospective chart review of all patients undergoing bilateral stapedectomy by two surgeons in a single institution over a 39-year period.

Results: Included were 426 patients (852 ears). A total of 52% of patients who had a white or obliterated footplate noted at primary surgery had a similar contralateral finding, compared to only 6.2% of second ear surgeries in those without such disease in the primary ear (p = 0.000, chi-square test). Where a drill-out was required in the first ear, 39% required a drill-out procedure in the second ear in contrast to only 6% requiring a second ear drill-out who did not require this during the first operation (p = 0.000, chi-square test). The finding of an overhanging or dehiscent facial nerve in the second ear is significantly higher if such an abnormality is identified during the first procedure (23% vs. 2.5%) (p = 0.005, Fisher's exact test). A drill-out had a 2.9-fold increase in unsuccessful outcome versus those not requiring drill-out (OR, 2.89, 95% CI 1.41 to 5.89).

Conclusion: This study confirms that bilateral advanced footplate obliteration and anomalous facial nerves may be anticipated in patients found to have these abnormalities at initial stapedectomy. Hearing results are poorer with second ear drill-out, regardless of a successful outcome of the first procedure, and this maneuver is more likely if required in the first ear.