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 15dB. SNHL was identified as cases with decrement in bone conduction thresholds greater than 10 or 5dB. 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.