In stapedotomy for otosclerosis, a piston prosthesis is inserted from the incus long process to a small fenestration in the footplate. What is the MOST feared early complication specific to this procedure?

• A Facial nerve palsy from inadvertent injury to the facial nerve in the oval window region
• B Tympanic membrane perforation from the speculum
• C Sensorineural hearing loss from acoustic trauma of drilling
• D Perilymph gusher — sudden profuse perilymph flow from the footplate fenestration ✓

Explanation

A perilymph gusher (also called perilymph fistula or 'gusher') is the most feared intraoperative complication of stapedotomy, occurring when the stapedial footplate is fenestrated and the perilymph pours out under pressure. This occurs due to an abnormal communication between the subarachnoid space (CSF) and the perilymph space — often associated with congenital inner ear malformations (e.g., incomplete partition type II, X-linked stapes gusher/POU3F4 mutation). It can result in profound SNHL. Facial nerve injury is a risk but less catastrophic. Gusher is the most feared early complication requiring immediate packing.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.