Stapedotomy With Adipose Tissue Seal: Hearing Outcomes, Incidence of Sensorineural Hearing Loss, and Comparison to Alternative Techniques

Objective: To evaluate hearing outcomes and incidence of sensorineural hearing loss (SNHL) after stapedotomy with adipose tissue seal, and to compare adipose tissue sealing with alternative techniques. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Primary stapedotomy was performed in 179 patients using a KTP laser, microdrill, piston prosthesis, and adipose tissue seal of the oval window fenestra between 1991 and 2015. An additional 123 patients underwent stapes surgery with alternative techniques. Interventions: Stapes surgery for otosclerosis. Audiograms were performed preoperatively and 3 months postoperatively. Main Outcome Measures: Hearing outcomes were measured as percentage of cases with closure of the air-bone gap (ABG) to within 10 and 15 dB. SNHL was identified as cases with decrement in bone conduction thresholds greater than 10 or 5 dB. The median postoperative ABG and change in bone conduction thresholds were compared between the primary stapedotomy group (KTP laser with adipose tissue seal) and various subgroups with alternative techniques. Results: We found excellent hearing outcomes after primary stapedotomy with adipose tissue seal. The ABG closed to within 10 dB in 81.01% of cases and within 15 dB in 93.30% of cases. We observed a low rate of SNHL without any cases of profound hearing loss. 1.67% of cases had a decrement in bone conduction greater than 10 dB while 6.14% of cases had a decrement greater than 5 dB. Stapedotomy with adipose tissue seal compared favorably with alternative techniques with respect to hearing outcomes and SNHL. Conclusions: Adipose tissue is an effective and cost-efficient tissue seal during stapedotomy with excellent hearing outcomes and low incidence of SNHL.

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