(868) Patient Risk Factors for Post-Stapedectomy Tympanic Membrane Retraction, A Rare Complication After Stapedectomy

Introduction: Stapedectomy provides excellent hearing outcomes for patients with otosclerosis. However, a subset of patients may develop postoperative tympanic membrane (TM) retraction or prosthesis extrusion, which can lead to hearing loss and the need for revision surgery. This study aims to identify factors associated with post-stapedectomy TM retraction and extrusion of the stapes prosthesis.

Methods: Patients who underwent primary stapedectomy between 2010 and 2024 at a tertiary-care academic medical center were retrospectively reviewed. Pre- and postoperative audiometric measures, medical comorbidities, and otologic history were analyzed.

Results: A total of 445 patients met inclusion criteria. In this cohort, the incidence of postoperative TM retraction was less than 1%.  A documented history of eustachian tube dysfunction (ETD) was more common among patients who developed TM retraction following stapedectomy (25%) compared with those without a preoperative history of ETD (8%), (OR 3.6, 95% CI 0.05–91.9, p = 0.04). Speech reception thresholds improved significantly following surgery, with a mean improvement of 25.9 dB (Wilcoxon signed-rank test, p = 0.0003). The air–bone gap at 2 kHz also improved significantly, decreasing from a mean of 20.2 dB preoperatively to 5.0 dB postoperatively (mean closure 15.3 dB; Wilcoxon signed-rank test, p = 0.007).

Conclusions: This is one of the largest studies examining an uncommon complication after stapedectomy. Understanding risk factors for postoperative TM retraction may be important for otolaryngologists to counsel patients, modify perioperative management, and employ surgical techniques protecting the eardrum to reduce complications after stapedectomy.