Stapes Surgery in Patients with a Small Air-Bone Gap

Abstract

The objective of this study was to determine hearing outcomes in patients undergoing stapes surgery with a preoperative air-bone gap (ABG) <21.25 dB. Patients with a unilateral or bilateral preoperative ABG <21.25 dB undergoing primary stapes surgery were identified from a database of all stapes surgeries performed in a tertiary center over 15 years. A total of 254 ears met the inclusion criteria. The primary outcome measure was the degree of closure of the preoperative ABG. A secondary outcome measure was improvement in bone-conduction thresholds at 4 kHz. All patients underwent stapes surgery under local anesthesia. Ossicular reconstruction was achieved using a SMart 360 nitinol fluoroplastic piston (Gyrus ACMI, Inc.; South-borough, Mass.), and complete posterior crurotomy was performed with a KTP laser. Hearing was assessed with clinical voice testing immediately postoperatively and with pure-tone audiometry at 6 weeks postoperatively. A total of 248 ears (97.6%) demonstrated ABG closure to <10 dB. Bone-conduction thresholds showed an increase in 114 (44.9%), no change 74 (29.1%), and a decrease in 66 (26.0%). There is a slight increase in the risk of stapes mobilization in ears with a small ABG when compared to those with larger ABGs; however, this can be overcome by using a laser-assisted technique in combination with good surgical experience. The benefit in terms of hearing aid avoidance and the restoration of symmetrical hearing is both achievable and significant for the patient.

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

“…Though our results show an overall favorable outcome and high success rates in cases with less than 20 dB preoperative ABG (72.7% 10 dB postoperative ABG, 97.0% 20 dB postoperative ABG) and no significantly higher rate of cases with negative relative hearing improvement, we found a significantly higher rate of cases with negative relative ABG closure compared with the subcohorts with a higher preoperative ABG. Therefore, we support the hypothesis of Salvinelli et al (38), Lippy et al (39), and Lavy and McClenaghan (40), that performing stapes surgery in cases with less than 20 dB preoperative ABG is overall safe and should-beside hearing aids-also be considered as an early treatment option in otosclerosis. Nevertheless, we advise higher precautions in the selection of these cases and a more thorough preoperative informed consent counseling.…”

Audiometric and Self-Reported Outcomes in Patients with Otosclerosis and a Small Air-Bone Gap after Stapes Surgery

“…The 6-month F/U showed ABG closure within 10 dB in almost 80% of operated ears. The results of this study are comparable to other similar studies examining the use of stapedotomy in patients with sABG [9, 10, 12, 13]. In most of these studies, the authors are in favor of performing stapes surgery in patients with an sABG.…”

“…The main determinant in deciding on stapes surgery in patients with otosclerosis is the degree of hearing loss, specifically the size of the preoperative air-bone gap (ABG). The debate over the minimum ABG centers on the risk-to-benefit ratio of stapes surgery in patients with small ABG (sABG) [8, 9]. Most surgeons usually prefer to wait for a change of at least 25–40 dB in the ABG before performing surgery [10, 11].…”

“…As pointed out by Alberti and colleagues in 2017, performing stapes surgery in patients with an ABG of less than 25 dB, which is considered small [11,12], remains controversial [11]. This is confirmed by only a small number of articles presenting the results of stapes surgery in patients with an sABG [9][10][11][12][13]. The conclusions of the retrospective studies concerning the appropriateness of stapes surgery in patients with an sABG are inconclusive.…”

Stapes Surgery for 121 Patients With Mixed Hearing Loss

“…A potassium titanyl phosphate laser was used for complete posterior crurotomy, as a crucial step in the surgery. 11 Postprocedure hearing was assessed using clinical voice testing, after the tympanic membrane was replaced.…”