Printer Friendly

Poststapedectomy reparative granuloma.

A 61 year-old man presented with the classic history of otosclerosis. After a trial with a hearing aid for several months, he opted for surgery. The diagnosis of otosclerosis was confirmed at surgery, and a total stapedectomy was performed. A 0.8-mm fluoroplastic prosthesis was inserted, and the oval window niche was sealed off with fat.

Postoperatively, the patient developed persistent mild dizziness and fluctuating sensorineural deafness. Examination did not reveal any significant abnormality until 4 weeks postoperatively, when a reddish intratympanic mass was seen on otoscopy. A clinical diagnosis of reparative granuloma was made, and tympanotomy and revision stapedectomy were performed. At surgery, a brownish intratympanic mass was found encasing the stapes prosthesis and the incus (figure). This is a typical finding with a reparative granuloma.


Management of a reparative granuloma involves early surgical intervention and complete removal of the granuloma, with or without prosthesis replacement. In the case described herein, the patient's deafness did not resolve despite early surgical intervention and revision surgery. This finding is compatible with other reports in the literature. (1)

The formation of reparative granuloma is one of the leading causes of sensorineural hearing loss following stapedectomy. Estimates of its incidence range from 0.1 to 3%. (1,2)

The pathogenesis of poststapedectomy reparative granuloma is unclear, but it is believed to be the result of a host response to trauma of the middle ear mucosa. The condition is known to be more common in patients whose oval window was sealed with Gelfoam; it has also occurred when fat and fascia have been used. Patients who undergo stapedotomy tend not to experience this complication. (1)

The typical presenting symptom is sensorineural hearing loss in the operated ear within 6 weeks of stapes surgery following a period of initial improvement. Otoscopic examination usually shows a reddish intratympanic mass, typically located in the posterosuperior quadrant. The patient's speech discrimination score is usually less than 60%. A few patients will experience disequilibrium. When a diagnosis of reparative granuloma is made, early surgical intervention is indicated.


(1.) Schuknecht HF. Otosclerosis surgery. In: Nadol JB Jr., Schuknecht HE eds. Surgery of the Ear and Temporal Bone. New York: Raven Press: 1993:238.

(2.) Kaufman RS, Schuknecht HF. Reparative granuloma following stapedectomy: A clinical entity. 1967. Ann Otol Rhinol Laryngol 1997;106:5-14.

Willis S.S. Tsang, FRCS (ORL); John K.S. Woo, FRCS (ORL); Michael C.F. Tong, MD
COPYRIGHT 2006 Vendome Group LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2006, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
Printer friendly Cite/link Email Feedback
Author:Tong, Michael C.F.
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Sep 1, 2006
Previous Article:'Full-time' faculty: an evolving construct?
Next Article:Endoscopic view of a hypermobile tongue in the nasopharynx.

Related Articles
Teflon granuloma.
Pedunculated granuloma of the vocal fold.
Giant-cell reparative granuloma.
Multiple bilateral vocal fold cysts and recurrent pyogenic 'granuloma'.
Incidental granulomatous inflammation of the uterus.
Plasma cell granuloma of the thyroid with Hashimoto's thyroiditis: report of a rare case. (Original Article).
Giant-cell reparative granuloma of the temporal bone: a case report and review of the literature.
Cholesterol granuloma.
Otitis media with effusion in a patient who had previously undergone a stapedectomy.
Vocal process granuloma.

Terms of use | Copyright © 2017 Farlex, Inc. | Feedback | For webmasters