Analysis of indications, intraoperative findings, and audiologic outcomes of pure endoscopic revision stapes surgery: A multicenter study

OBJECTIVE: This retrospective multicenter study aims to provide a comprehensive analysis of the causes of revision and audiologic outcomes in cases that underwent revision stapes surgery (SS) a pure endoscopic transcanal approach over 10 years. METHODS: This study analyses the outcomes of patients who underwent exclusive endoscopic revision SS between January 2015 and March 2025. These cases were either the authors' own cases or cases referred from other centers for the management of SS complications, as well. RESULTS: A total of 113 patients (42 males (37.2%), 71 females (62.8%), with an average age of 40.4 ± 8.6 years, age range: 10-68, who had previously undergone SS and underwent revision SS were included in the study. The most common intraoperative findings were prosthesis-related troubleshoots (prosthesis being too short (n = 41, 36.3%) or too long (n = 21, 18.6%), prosthesis dislocation from incus: 38 (33.6%)) and incus long process (ILP) necrosis (n = 33, 29.2%). After endoscopic revision SS, the average pre-op ABG value of 29.8 ± 10.1 dB improved to 13.7 ± 5.2 dB postoperatively (p < 0.001). 75.2% (85/113) of patients achieved post-op ABG values below 20 dB. CONCLUSION: The need for revision in SS depends on various factors, including the surgeon, the patient, and prosthesis-related issues. Endoscopes are advanced diagnostic and surgical tools that provide high-resolution, dynamic and panoramic images of the entire middle ear structures, enabling accurate diagnosis of the problem. The endoscopes permit the surgeon to perform revision SS with a high degree of precision through a purely transcanal approach, thereby achieving audiological outcomes that are consistent with the range of reports in the literature for conventional microscopic revision SS.