Outcome measures in stapes surgery: postoperative results are independent from preoperative parameters

Abstract

The aim of this study was to compare audiometric results before and after stapes surgery and identify potential prognostic factors to appropriately select patients with otosclerosis who will most likely benefit from surgery. We enrolled 126 patients with otosclerosis (162 consecutive ears) in our study who underwent stapes surgery between 2007 and 2012 at our institution. Preoperative and postoperative data including pure-tone audiometry, speech audiometry, stapedial reflex audiometry and surgical data were analyzed. The average preoperative air-bone gap (ABG) was 28.9 ± 8.6 dB. Male patients and patients older than 45 years of age had greater preoperative ABGs in comparison to females and younger patients. Postoperative ABGs were 11.2 ± 7.4 dB. The average ABG gain was 17.7 ± 11.1 dB. Preoperative audiometric data, age, gender and type of surgery did not influence the postoperative results. Stapes surgery offers predictable results independent from disease progression or patient-related factors. While absolute values of hearing improvement are instrumental in reflecting audiometric results of a cohort, relative values better reflect individual's audiometric data resembling the patient's benefit.

A Retrospective Study: Good Functional Outcomes are Independent of Pre-Operative Factors in Stapes Surgery for Otosclerosis

“…This is in agreement with our finding that the achievement of ideal post-op ABG is independent of the magnitude of pre-operative ABG. These findings are consistent with the recent study by Koopman who similarly could not demonstrate any pre-operative factors that significantly influences post-surgical ABG outcome [16]. He also reported a greater ABGi in patients with higher pre-operative ABG (≥ 29 dB).…”

“…Our current study reports a mean ABGi gain after surgery of 78.8% with 78.9% (n = 71) patients achieving an ABGi of 70%. The only other study that incorporated measurement of percentage improvement in ABG levels was by Koopman [16] who reported a mean ABGi of about 53%. He also encouraged the incorporation of "relative gain" in pre-operative counseling for patient and supported the role of ABGi as such a measure.…”

“…In the second part of our study, we aimed to investigate the role of pre-operative clinical and audiological factors in predicting surgical success. Compared to ossiculoplasty [18][19][20][21], there is currently a paucity of information and a lack on consensus with regards to prognostic factors relating to stapes surgery [6][7][8]16,22,23]. Studies by Ueda, et al [8] and Bittermann [6] both found that a smaller pre-operative ABG had better closure of post-operative ABG.…”

Analysis of the cases of otosclerosis

“…Ameliyat sonrası HKA değerinin 10 dB ve altına düşmesini başarı kabul edenler olduğu gibi 20 dB ve altını başarı kabul eden çalışmalar da vardır. [4,7,8] Bu çalışmada fonksiyonel başarı HKA'nın 20 dB ve altına düşmesi olarak kabul edildi ve olguları-mızın %85.1'inde fonksiyonel başarı elde edildi. Ayrıca HKA'nın Denoyelle ve ark.nın [5] yaptıkları şekilde çok iyi, iyi, kabul edilebilir ve başarısız olarak değerlendirdiğinde; hastaların %42.5'i çok iyi, %42.5'i iyi, %11.1'i kabul edilebilir ve %3.7'si ise başarısız olarak kabul edildi.…”

“…Yakın zamanda yapılan bir çalışmada hastaların %87.7'sinin HKA'sının 20 dB ve altına düştüğü gösteril-miştir. [8] Topdağ ve ark. [7] yaptıkları çalışmada 100 hastayı retrospektif incelemiş ve HKA'sı 10 dB ve altına düşen hasta oranını %50.4, 20 dB ve altına düşen hasta oranının ise %91.3 olduğunu bildirmişlerdir.…”