Abstract
Objective: Purpose of this study is to review the experience of other authors and to present our experience with the stapes 'gusher' regarding the clinical and radiological findings, intraoperative and postoperative management.
Materials and Methods: In the period from 1998 to 2008, 83 patients (107 ears) diagnosed with otosclerosis were operated at the Department of Otorhinolaryngology of Ain Shams University Hospitals. From the 107 ears, we encountered six cases (5.6%) of perilymph gusher during stapedectomy. Five patients had familial history of decreased hearing in male brothers and audiological examination of the brothers showed mixed hearing loss and the last patient was a female patient who showed history of decreased hearing in 2 sisters. CT-scan temporal bone was done in the six patients, postoperatively in 2 cases and preoperatively in 4 cases. Only one of them showed wide cochlear aqueduct. In the six cases piston with fat seal around was placed.
Results: The perilymphatic leak was stopped effectively in three patients intraoperatively. In the other three patients the leak continued from 4 to 13 days postoperatively, in these patients there was marked postoperative vertigo. Three patients showed marked improvement in hearing, one patient showed mild improvement in hearing and two patients encountered sensorineural hearing loss and needed hearing aids.
Conclusion: We can conclude from our work and other authors' experience that anticipation of a stapes gusher preoperatively should be suspected if there is an X-linked family history of hearing loss in individuals who show a mixed type of hearing loss. In all of these cases, a high resolution, thin section CT should be performed, looking for abnormalities of the internal auditory canal, cochlear aqueduct and the labyrinthine structures.