Vestibular granuloma as a rare post-stapedotomy complication: case report and literature review

Background: Vestibular granuloma is a rare complication of a common surgical procedure, such as stapedotomy; it can significantly impact the outcome of surgery, leading to severe impairment and deterioration in the patient’s quality of life. Case report: A 59-year-old male underwent stapedotomy with a titanium prosthesis. Initially, hearing function improved but, within days, the patient developed vertigo and worsened hearing loss. HR CT of temporal bone revealed soft tissue in the tympanic cavity, prompting revision surgery. Granulomatous tissue surrounding the prosthesis was removed, leading to symptom relief. However, the patient later developed Persistent Postural-Perceptual Dizziness (PPPD), requiring SSRI therapy. Discussion: The sudden onset of persistent vertigo and hearing loss, that rapidly worsens in post-operative setting, represents a crucial red flag for the surgical team. Hearing assessments and imaging play a key role in quickly diagnosing the cause of these complications, which may be attributed to an inflammatory response at the surgical site, possibly due to granuloma formation. This enables the surgical équipe to swiftly implement appropriate care strategies for the patient, even in the presence of additional and subsequent complications like PPPD, which requires a comprehensive, multimodal approach to treatment. Conclusion: This case highlights the risk of a series of complications after surgery and even after reoperation, ultimately requiring conservative multimodal treatment and follow-up. Early recognition and coordinated care are essential for optimal long-term management of patients, even in the presence of unfavorable outcomes and complications.