Acute Inner Ear Complications of Stapes Surgery: Value of Delayed Postcontrast 3D-FLAIR MRI Sequences.

Objective: To describe and assess the usefulness of delayed postcontrast three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences on 3-Tesla (3 T) magnetic resonance imaging (MRI) in patients presenting with acute inner ear complications after stapes surgery.

Study Design: Case series.

Setting: French tertiary referral center.

Methods: The clinical records and imaging of patients who underwent delayed postcontrast 3D-FLAIR MRI sequences for labyrinthine complications after stapes surgery, performed between January 2019 and April 2023, were retrospectively reviewed.

Results: A total of 712 patients underwent stapes surgery between January 2019 and December 2023. Eight patients (1.12%) were included in the study, with a median age of 52 years (interquartile range 40-54). After the surgery, seven patients presented with vertigo and sensorineural hearing loss (SNHL), and one patient presented with only vertigo with complete areflexia on caloric testing. Computed tomography (CT) of the temporal bone showed a slightly excessive penetration of the prosthesis (>1 mm) into the vestibule in one patient and a periprosthetic granuloma in another patient. CT was normal for six patients. Delayed postcontrast 3D-FLAIR MRI sequences showed blood-labyrinth barrier (BLB) impairment in the cochlea, the vestibule, and the semicircular canals in seven patients. No endolymphatic hydrops were found, but one patient presented with utricular collapse, and the saccule was not visible in three other patients.

Conclusion: Delayed postcontrast MRI sequences may reveal BLB impairment and help analyzing the endolymphatic compartment in cases of SNHL or vestibular disorders after stapes surgery. Those sequences could help uncovering the causes of such events.