Endoscopic Stapedectomy: Does Oval Window Packing Matter?

Objective: To determine whether differences in audiometric outcomes and postoperative vertigo exist among different approaches to oval window packing after endoscopic stapedectomy. Study Design: Retrospective chart review. Setting: Academic tertiary care otology-neurotology practice. Patients: Patients who underwent endoscopic stapedectomy from 2017 to 2023. Interventions: Oval window reinforcement was performed with one of five techniques: lobular fat graft, promontory blood patch, both, other autologous patch, or none. Main Outcome Measures: Our primary outcome measures were subjective postoperative vertigo, change in air-bone gap (ABG; 250–4000 Hz), and air-conduction pure-tone average (PTA; 500/ 1000/2000/4000 Hz). Patient and surgical variables such as age, sex, laterality, surgeon, primary versus revision surgery, laser versus drill stapedotomy, and prosthesis type and length were secondarily investigated. Results: A total of 256 ears of 220 patients (mean age, 47.8 ± 12.9 yr) were included for analysis: 143 received promontory blood patch; 54, lobular fat graft; 10, both blood patch and fat graft; 2, temporalis fascia or tragal perichondrium; and 47, no reconstruction. There was no difference in incidence of subjective postoperative vertigo between groups at first and most recent follow-up (p = 0.92 and p = 0.76, respectively). Average improvements in ABG and PTA were not significantly different among groups at first (p = 0.35 and p = 0.27, respectively) and most recent audiograms (p = 0.87 and p = 0.99, respectively). Although there were also no significant differences in percentage of patients achieving ABG closure to within 20 or 10 dB at first postoperative audiogram (p = 0.48 and p = 0.51, respectively), blood patch yielded higher ABG closure to within 10 dB (p = 0.048), but not within 20 dB (p = 0.48) at second postoperative visit. Conclusions: Blood patch reconstruction may yield better long-term ABG closure compared with fat graft packing and no reconstruction alternatives to oval window reconstruction after endoscopic stapedectomy.