Successful stapedoplasty complicated by a perilymphatic gusher: immediate sealing via piston placement

Czech version

Authors: Ł. A. Pochroń; R. Salzman
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku LF UP a FN Olomouc
Published in: Otorinolaryngol Foniatr, 75, 2026, No. 2, pp. 172-177.
Category: Case Reports
doi: https://doi.org/10.48095/ccorl2026172

Overview

Gusher syndrome is a rare but serious complication of stapedoplasty, typically associated with congenital malformations of the inner ear. It presents as a profuse fluid leak during platinotomy, where the initial milliliters consist of perilymph, while the subsequent flow represents cerebrospinal fluid. We present the case of a 55-year-old patient in whom the procedure was successfully completed despite the occurrence of gusher syndrome, thanks to prompt intraoperative intervention, use of perichondrial sealing, and piston implantation. Postoperatively, a lumbar drain was inserted, which led to the gradual cessation of otorrhea. The patient experienced no neurological or vestibular symptoms, and the hearing gain remained stable even one year after surgery. According to the available literature, gusher syndrome often results in significant hearing loss or even complete deafness. This case report demonstrates that with a calm and structured approach, and by choosing the correct surgical strategy, the operation can be completed with favorable auditory outcome.

Keywords:

otosclerosis – gusher synrome – stapedoplasty

Sources

1. Salzman R, Bakaj T, Heřman J et al. Endoskopická ušní chirurgie: shrnutí problematiky. Otorinolaryngol Foniatr 2016; 65 (3): 184–187.

2. Schuknecht HF, Reisser C. The morphologic basis for perilymphatic gushers and oozers. Adv Otorhinolaryngol 1988; 39 : 1–12.

3. Ginsberg IA, Hoffman SR, Stinziano GD et al. Stapedectomy--in depth analysis of 2405 cases. Laryngoscope 1978; 88 (12): 1999–2016. Doi: 10.1288/00005537-197812000-00014.

4. Šikolová S, Urík M, Jančíková J et al. Vrozené vývojové vady vnitřního ucha. Otorinolaryngol Foniatr 2021; 70 (3): 167–173.

5. Katra R, Pourová R, Dytrych P et al. Pendredův syndrom v České republice. Otorinolaryngol Foniatr 2011; 60 (2): 103–111.

6. Cremers CW, Snik AF, Huygen PL. X-linked mixed deafness syndrome with congenital fixation of the stapedial footplate and perilymphatic gusher (DFN3). Adv Otorhinolaryngol. 2002; 61 : 161–167. Doi: 10.1159/000066826.

7. Wiet RJ, Harvey SA, Bauer GP. Complications in stapes surgery. Options for prevention and management. Otolaryngol Clin North Am 1993; 26 (3): 471–490.

8. Alicandri Ciufelli M, Molinari G, Rosa MS et al. Gusher in stapes surgery: a systematic review. Eur Arch Otorhinolaryngol 2019; 276 (8): 2217–2225. Doi: 10.1007/s00405-019-05566-1.

9. Quesada JL, Cammaroto G, Bonanno L et al. Cerebrospinal fluid leak during stapes surgery: gushing leaks and oozing leaks, two different phenomena. Ear Nose Throat J 2017; 96 (8): 302–308. Doi: 10.1177/014556131709600817.

10. Causse JB, Causse JR, Wiet RJ et al. Complications of stapedectomies. Am J Otol 1983; 4 : 275–280.

11. Young YH, Hsu CJ, Yang CC et al. Perilymphatic gusher in stapedectomy: demonstration of a fistula of internal auditory canal. Otol Neurotol 2003; 24 (6): 1026–1031. Doi: 10.1097/00129492-200311000-00022.

12. Wootten CT, Backous DD, Haynes DS. Management of cerebrospinal fluid leakage from cochleostomy during cochlear implant surgery. Laryngoscope 2006; 116 (11): 2055-2059. Doi: 10.1097/01.mlg.0000240286.43289.87.

13. Crohan W, Krishnaswamy J, Rajan G. The effects of gusher-related intracochlear pressure changes on hearing preservation in cochlear implantation: a comparative series. Audiol Neurootol 2018; 23 (3): 181–186. Doi: 10.1159/000489599.