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Gusher in stapes surgery: a systematic review

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Abstract

Objective

The aim of this study is to perform a systematic literature review on the occurrence of gusher during stapes surgery, to understand its surgical management and outcomes.

Methods

The PRISMA standard was applied to identify English, Italian or French-language studies, related to stapes surgery and mentioning gusher or perilymphatic leak. Full-texts lacking information on the management of gusher and/or the post-operative hearing outcome were excluded.

Results

Twenty-four articles were eventually included. Seventy-six patients were involved in the qualitative synthesis. The management of gusher mostly consisted in covering the oval window and/or filling the tympanic cavity, with absorbable and autologous graft materials. Packing of the external auditory canal was reported in 51 patients (67%). Gusher was related to complete/profound loss of hearing in 25% of the cases and to a worsening of hearing function in 31% of patients. In 19% of patients an improvement in hearing tests was reported; in 28% the hearing function was unchanged. Post-operative vestibular symptoms were reported in 7 patients, and were mainly mild and transient. The absence of vestibular symptoms was underlined in 9 cases, while in 79% of the patients the authors did not provide information.

Conclusion

The unexpected occurrence of gusher during stapes surgery represents a relevant issue for the otologic surgeon. Its management most commonly consists in plugging the oval window and the tympanic cavity. In most of the cases, a stapes prosthesis could be positioned. The results on hearing and vestibular functions are widely variable.

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Authors and Affiliations

  1. Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy

    Matteo Alicandri-Ciufelli, Giulia Molinari, Maria Silvia Rosa, Daniele Monzani & Livio Presutti

Authors
  1. Matteo Alicandri-Ciufelli
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  2. Giulia Molinari
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  3. Maria Silvia Rosa
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  4. Daniele Monzani
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  5. Livio Presutti
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Correspondence to Maria Silvia Rosa.

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Alicandri-Ciufelli, M., Molinari, G., Rosa, M. et al. Gusher in stapes surgery: a systematic review. Eur Arch Otorhinolaryngol 276, 2363–2376 (2019). https://doi.org/10.1007/s00405-019-05538-x

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