{Reference Type}: Journal Article
{Title}: Gusher in stapes surgery: a systematic review.
{Author}: Alicandri-Ciufelli M;Molinari G;Rosa MS;Monzani D;Presutti L;
{Journal}: Eur Arch Otorhinolaryngol
{Volume}: 276
{Issue}: 9
{Year}: Sep 2019
{Factor}: 3.236
{DOI}: 10.1007/s00405-019-05538-x
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.