A recurrence of conductive deafness following a stapedectomy with a temporary good postoperative result can be due either to reclosure of the oval window by bone growth or to interruption of the ossicular chain. In tympanoplasty multiple causes are possible, such as interruption of the chain or refixation of the stapes. Whether by closure of the window or through fixation of the stapes there is a slowly increasing hearing loss until the preoperative level is reached. If a hearing gain is suddenly lost it might indicate a slipped strut or disrupted ossicular chain. During the years in which we performed stapedectomies and tympanoplasties a peculiar phenomenon was occasionally observed. There are some patients who postoperatively have an intact drum or flap and a well-functioning eustachian tube, but their hearing changes in an alternating way. It will be distinctly better during or after a Valsalva's maneuver and will worsen after swallowing.
BEICKERT P. Alternation of Hearing After Tympanoplasty And Stapedectomy: The Phenomenon of Tension. Arch Otolaryngol. 1964;80(4):383–387. doi:10.1001/archotol.1964.00750040395004
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