Learning Objectives: Surgical debulking can be beneficial in cases refractory to medical therapy. Although it is a rare complication, post-stapedectomy granuloma should be considered in any patient presenting with tinnitus, otalgia, vertigo or hearing loss after stapes surgery.

Introduction: Our aim was to report cases of post-stapedectomy granuloma and examine outcomes following surgical debulking.

Methods: Retrospective case review. Three patients presenting with otalgia following stapedectomy between 2010 and 2015. Tinnitus, hearing loss and facial paralysis occurred in two of these cases. When symptoms failed to improve despite maximal medical therapy, patients underwent exploratory tympanotomy and exenteration of granuloma.

Results: Intra-operatively, granulation tissue consistently surrounded the oval window niche, prosthesis and long process of the incus, emulating radiographic findings. The granulomatous reaction spread along the seventh and eight cranial nerves to reach the cochlear nucleus in one patient. In all cases, clinical improvement was demonstrable although symptoms failed to completely resolve. Overall, facial nerve function recovered, variable reductions in pulsatile tinnitus occurred and otalgia persisted in all cases. Diminution of contrast enhancement on serial MRI scans corroborated clinical improvement and permitted post-operative monitoring of disease recurrence. Post-operative complications included Grade IV facial weakness and a pseudomonas aeruginosa meningitis, both of which completely recovered.

Conclusion: To the authors' knowledge, this is the only case where granuloma has tracked to the brainstem. Surgical debulking was beneficial in these three cases of post-stapedectomy granuloma refractory to medical therapy. Although it is a rare complication, post-stapedectomy granuloma should be considered in any patient presenting with tinnitus, otalgia, vertigo or hearing loss after stapes surgery.