A patient undergoing stapedectomy for otosclerosis develops sensorineural hearing loss in the immediate postoperative period. The most common cause of this 'cochlear dead ear' following stapedectomy is:

• A Fracture of the crura with trauma to the membranous labyrinth or perilymph fistula ✓
• B Endolymphatic hydrops from perilymph loss
• C Suppurative labyrinthitis
• D Postoperative otitis media with effusion

Explanation

The most feared complication of stapedectomy/stapedotomy is sensorineural hearing loss (cochlear dead ear). The most common cause is mechanical trauma to the membranous labyrinth (specifically the saccule or utricle) or membranous cochlea during crura fracture, excessive footplate manipulation, or creation of too large a stapedotomy — leading to perilymph fistula and inner ear injury. This risk is minimized by use of a small fenestra stapedotomy technique with a laser. Suppurative labyrinthitis can also cause SNHL but is less common than direct mechanical trauma.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.