How Long Is Otosclerosis Surgery Effective? Hearing Results after a 22-Year Follow-Up

Abstract

Introduction: Stapes surgery is a safe procedure, with favourable hearing outcome. The objective of the study is to assess the long-term hearing results, addressing the bone conduction (BC) decay and the need for hearing aids in otosclerosis patients. Methods: We enrolled patients who underwent stapes surgery by means of stapedectomy or stapedotomy between 1991 and 2001. All enrolled patients underwent pure-tone audiometry (PTA) between September 2017 and June 2018. A set of questions was administered to record the prevalence of subjective symptoms and the need for hearing aids. Results: Seventy patients were enrolled for a long-term evaluation; 37 patients underwent bilateral surgery; therefore, 107 ears were included in the analysis. The average follow-up period was 22 years. No statistically significant difference was found between early and late post-operative air conduction (AC) PTA (41 vs. 49 dB; p > 0.05) nor between early and late post-operative BC-PTA (29 vs. 37 dB; p > 0.05). A significant difference was observed for AC at 8 kHz (65 vs. 78 dB; p < 0.05) and BC at 2 and 4 kHz (28 vs. 40 dB and 45 vs. 58 dB, respectively; p < 0.05). Conclusions: This is, to our knowledge, the longest mean follow-up time in the literature. A mild decrease in both AC and BC threshold can be expected and the sensorineural decay is more pronounced on the high frequencies. The subjective hearing symptoms and overall sound perception are satisfactory.

Estimated Costs Associated With Management of Otosclerosis With Hearing Aids vs Surgery in Europe

“…5 , 7 Reported reoperation rates vary from 2% within 13 years to 10.5% over 15 years. 6 , 7 , 8 The proportion of major middle-ear surgeries performed as outpatient procedures ranged from 27% to 90.4%, depending on the year and treatment center considered. 4 , 22 Otosclerosis was bilateral in 75% of cases but often asymmetric, with surgical treatment of both ears in 27% to 34% of cases within 15 to 20 years.…”

“…27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 The proportion of patients using hearing aids within 10 years after surgery ranged from 29% to 54%. 7 , 9 There was no information available in the literature regarding the proportion of patients receiving surgery or hearing aids as first-line treatment. In the United-States, 67% of patients diagnosed with otosclerosis are first treated surgically.…”

“…The parameters of the model, derived from the epidemiological analysis, are presented in Table 2 . 2 , 4 , 7 , 8 , 12 , 26 , 36 For the hearing aid group, costs were determined on a yearly basis, with a new device every 4 years ( Table 2 ). Based on audiologists’ estimates and sales figures provided by the Syndicat National de l’Industrie des Technologies Médicale, we assumed that 20% of patients using a hearing device would choose a class I device (the minimum target set by the state for audiologists in France), 35% would choose a class II, subgroup C or D device (class II), and 45% would choose a class II, subgroup E or F device (class III).…”

“… 4 The success rate is greater than 90%, and long term outcomes (>5 years) are good (residual air-bone gap lower than 10 dB) 1 , 5 , 6 , 7 , 8 , 9 , 10 , 11 and associated with a very low (ie, <1%) risk of deafness. 5 , 6 , 7 However, other complications need to be considered, such as (1) revision surgery because of decreased hearing, complications, or lack of improvement after the initial operation and (2) use of a hearing aid after surgery because of decreased hearing or insufficient improvement. 8 , 9 , 10 , 11 The risks related to surgery are therefore greater than those related to hearing aids and also have financial consequences.…”

“…Overall, surgery and hearing aids have similarly good outcomes in terms of hearing acuity but differ in terms of cost, aesthetics, and patient quality of life. 6 , 7 , 14 , 15 Given that there are very few contraindications for surgery (single ear and gusher syndrome), the choice of treatment is left to patients based on the benefits and risks of the 2 approaches. 5 However, the costs for public health insurance systems, patients, and private health insurers vary between treatment modalities and countries.…”