Second ear stapedectomy--a continued controversy.

Abstract

This paper presents the results of an investigation into the effects of stapedectomy on vestibular function. We detected a disturbingly high incidence of vestibular abnormality in the results of caloric tests at three months postoperatively. Surprisingly, this was not usually accompanied by concurrent vestibular symptoms and there was no evidence of cochlear dysfunction in most cases. Although the caloric response at 12 months postoperatively showed an improvement in most instances, the responses rarely became symmetrical. We believe that a long-term alteration in vestibular response is not uncommon following stapedectomy. Although most patients will compensate quite quickly after unilateral stapedectomy we suspect that this occurs much less readily after bilateral stapedectomy and not at all should bilateral impairment of vestibular function occur. On the basis of this evidence, we submit that bilateral stapedectomy is justified only when vestibular function can be shown to be normal prior to the second ear operation.