Stapes Surgery for 121 Patients With Mixed Hearing Loss

Abstract

This study aims to determine the benefit of stapes surgery for otosclerosis in 121 patients with a mixed hearing loss and a preoperative bone conduction (BC) threshold >30 dB. Average postoperative air conduction (AC) improved from 61.5 dB to 34.3 dB. Average air-bone gap closed from 27.1 dB to 6.1 dB. Bone conduction improved from 34.3 dB to 28.2 dB, with 38% of patients achieving a postoperative AC of <30 dB. Glasgow Benefit Inventory scores showed significantly increased quality of life postoperatively in the 88 patients who responded to follow-up, with an average score of 56. There was a mean reduction in daily hearing aid use postsurgery of 5.48 hours, with 56% of patients who responded to follow-up questionnaire no longer needing to use one. When assessing suitability for stapes surgery, surgeons should consider that preoperative BC thresholds may be a poor indicator of the true cochlear reserve and therefore the potential for improvement in AC thresholds and quality of life.

Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker

“…Residual postoperative ABG might be overrated by relative ABG closure, while Carhart effect is included in the calculation of relative hearing improvement. If depression of preoperative BC is related to a pre-existing sensorineural hearing loss, it will most likely not be accessible to stapes surgery (5,29).…”

The Impact of the Frequency-Specific Preoperative Sensorineural Hearing Loss to Postoperative Overclosure of Bone Conduction in Stapedotomy

“…Furthermore, a complication in a stapedotomy can cause an increase in SNHL, which can result in a functionally-deaf ear in advanced osteosclerosis (10). It is also thought that results after stapedotomy in cases of severe MHL are unpredictable because stapedotomy is not applicable for the treatment of patients with a preoperative SNHL component (11).…”

“…In Carhart's classic report, the effect was maximal at 2 kHz and was also described in the range of frequencies from 0.5 to 4 kHz. Thus, in patients with osteosclerosis, BC threshold can be artificially elevated preoperatively, which causes a problem for traditional candidate selection practices (11). Furthermore, the Carhart effect can be underestimated preoperatively, especially at low frequencies (14), indicating a possible frequency-dependent nature of the Carhart effect.…”