Reparative granuloma following stapes surgery

Abstract

Reparative granuloma of the oval window is an uncommon complication of stapes surgery, which usually develops within one to six weeks after operation and causes a sudden hearing loss and disturbance of balance. We report 2 cases of post-stapedectomy reparative granuloma that developed during the tenure of senior surgeon (AM).

Brazilian Society of Otology task force – Otosclerosis: evaluation and treatment

“… 247 , 248 , 249 , 250 Symptom onset may occur early, such as persistent hypoacusis, vertigo, or SNHL typically associated with intense tinnitus, or they may appear later in a sudden, fluctuating, or progressive manner, such as recurrent ABG. Except in cases of suspected perilymphatic fistula or granulation tissue, which according to some authors should be treated early, 251 an observational period of 6 weeks 252 to 3 months 253 is recommended. Because the outcomes of revision surgery in the literature are inferior to those of primary surgery, its indication should be carefully evaluated.…”

“… 112 , 252 , 253 Recurrent or increasing ABG may indicate erosion of the long process of the incus, prosthesis displacement, inadequately sized prosthesis, scar adhesions, ossification of the fenestra, or granuloma. 247 , 251 , 253 In up to 82% of cases, there is necrosis of the long process of the incus and/or prosthesis displacement. 253 Massimilla et al 257 investigated 21 patients with incus erosion who either received a new prosthesis placed proximally to the long process or underwent incus reconstruction with bone cement.…”

Post-stapedectomy granuloma: a devastating complication

“…Fat, venous blood or Gelfoam 4 are commonly used during stapes surgery to surround the piston in the oval window, in order to minimise the risk of perilymphatic fistula 12 when a vein graft has not been used. Some evidence suggests that prosthetic material (for example Teflon, stainless steel or gold) does not influence granuloma formation 7 9 , 11 , 13 Accidental foreign bodies, including cotton wool fibres and dust particles, have all been suspected to trigger this excess inflammatory reaction 11 .…”

“…Symptoms typically manifest one to six weeks post-operatively 7 as sensorineural dysacusis (70–100 per cent), vertigo (20–35 per cent), otalgia or tinnitus 4 8 – 10 The precise aetiology is not fully understood 4 .…”

“…, 8 – 10 The precise aetiology is not fully understood 4 . Whilst a foreign body reaction remains the most probable explanation, 5 , 9 , 11 pyogenic inflammation, autoimmune responses, allergic reactions and excessive healing are alternative theories 7 …”