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Otorhinolaryngology 2021 March;71(1):12-7

DOI: 10.23736/S2724-6302.20.02330-9


language: English

Visibility of the incudostapedial complex during stapes surgery: a novel classification

Ahmed HEMDAN , Mohammed A. SALEM, Yousef K. SHABANA, Mohammed R. GHONIM

Unit of Otology, Department of Otorhinolaryngology, Mansoura Faculty of Medicine, Mansoura, Egypt

BACKGROUND: Variation in the configuration of bone of the external auditory canal leads to variation in the incudostapedial complex visibility. The aim of this study was to classify the visibility of the incudostapedial complex during stapes surgery and assess its impact on hearing outcome and surgical complications.
METHODS: A prospective cohort study carried out on 385 cases with otosclerosis. The visibility of the incudostapedial complex was assessed together with the extent of bone removal from the posterosuperior canal wall. Postoperative hearing outcome and surgical complications were additionally evaluated.
RESULTS: According to the visibility of the incudostapedial complex, 4 types were classified in: 1) type 1 (fully visible incudostapedial complex including: the incudostapedial joint, the stapes tendon and the stapes footplate); 2) type 2 (the incudostapedial joint and the stapes tendon were visible but not the stapes footplate); 3) type 3 (the commonest type, where the incudostapedial joint was the only visible structure while the stapes tendon and the stapes footplate were hidden; 4) type 4 (hidden incudostapedial joint, stapes tendon and stapes footplate). The smallest postoperative air bone gap was reported in type 1 while the largest was in type 4 with statistically significant difference. The highest incidence of surgical complications was reported in type 4 while the least was in type 1 with statistically significant difference.
CONCLUSIONS: Hearing outcome and surgical complications are closely related to the type of visibility of the incudostapedial complex. Best hearing outcome was reported with fully visible type (type 1) together with the least incidence of surgical complications.

KEY WORDS: Stapes surgery; Otosclerosis; Otolaryngology

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