Predictors of hearing outcomes after stapes surgery in otosclerosis

Objective To systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches. Data Sources PubMed, Embase, and Web of Science. Review Methods An electronic search was conducted with the keywords “endoscop* or microscop*” and “stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation.” Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded. Results The database search yielded 1317 studies; 12 remained after dual-investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta-analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6-dB mean improvement in the change in air-bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery.

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A comparison between endoscopic and microscopic approaches for stapes surgery: a systematic review

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000821 ◽

2020 ◽

Vol 134 (5) ◽

pp. 398-403 ◽

Cited By ~ 2

Author(s):

H F Pauna ◽

R C Pereira ◽

R C Monsanto ◽

M S A Amaral ◽

M A Hyppolito

Keyword(s):

Systematic Review ◽

Surgical Technique ◽

Web Of Science ◽

Surgical Techniques ◽

Stapes Surgery ◽

Less Invasive Surgery ◽

Microscopic Approach ◽

Microscopic Surgery ◽

Hearing Outcomes ◽

Microscopic Techniques

AbstractObjectivesTo evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery.MethodsSystematic searches of the literature were performed in PubMed, Web of Science and Scopus databases, to identify studies of patients who underwent stapes surgery using endoscopic approaches and studies reporting objective post-operative hearing outcomes. The following information was extracted: surgery duration, complications, surgical technique and audiometric results.ResultsFourteen studies were selected for appraisal, which included a total of 282 ears subjected to endoscopic stapes surgery. Endoscopic stapes surgery seems to provide adequate visualisation of the middle-ear structures, thereby allowing less invasive surgery and potentially equivalent audiological outcomes as compared with a traditional microscopic approach. Other advantages of endoscopic stapes surgery include decreased surgery time, a reduced need for drilling, and auditory results comparable to those of microscopic techniques.ConclusionStudies have shown that endoscopic stapes surgery has similar surgical and functional advantages as compared with microscopic surgery.

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Audiological outcome of stapes surgery for far advanced cochlear otosclerosis

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001815 ◽

2017 ◽

Vol 131 (11) ◽

pp. 961-964 ◽

Cited By ~ 2

Author(s):

C Heining ◽

R Banga ◽

R Irving ◽

C Coulson ◽

P Monksfield

Keyword(s):

Hearing Loss ◽

Cochlear Implant ◽

Revision Surgery ◽

Cochlear Implantation ◽

Stapes Surgery ◽

Hearing Thresholds ◽

Suitable Treatment ◽

Conductive Component ◽

Clinically Significant ◽

Hearing Outcomes

AbstractBackground:Patients with advanced otosclerosis can present with hearing thresholds eligible for cochlear implantation. This study sought to address whether stapes surgery in this patient group provides a clinically significant audiological benefit.Objectives:To assess pre- and post-operative hearing outcomes of patients with advanced otosclerosis, and to determine what proportion of these patients required further surgery including cochlear implantation.Methods:Between 2002 and 2015, 252 patients underwent primary stapes surgery at our institution. Twenty-eight ears in 25 patients were deemed to have advanced otosclerosis, as defined by pure audiometry thresholds over 80 dB. The patients’ records were analysed to determine audiological improvement following stapes surgery, and assess whether any further surgery was required.Results:The audiological outcome for most patients who underwent primary stapes surgery was good. A minority of patients (7 per cent) required revision surgery. Patients who underwent cochlear implantation after stapes surgery (10 per cent) also demonstrated a good audiological outcome.Conclusion:Stapes surgery is a suitable treatment option for patients with advanced otosclerosis, and should be considered mandatory, before offering cochlear implantation, for those with a demonstrable conductive component to their hearing loss. A small group of patients get little benefit from surgery and subsequently a cochlear implant should be considered.

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Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution

International Archives of Otorhinolaryngology ◽

10.1055/s-0035-1563540 ◽

2015 ◽

Vol 20 (01) ◽

pp. 039-042 ◽

Cited By ~ 4

Author(s):

José Souza ◽

Ricardo Bento ◽

Larissa Pereira ◽

Liliane Ikari ◽

Stephanie Souza ◽

...

Keyword(s):

Hearing Loss ◽

Functional Outcomes ◽

Bone Conduction ◽

Stapes Surgery ◽

Educational Institutions ◽

Teaching Institution ◽

Bilateral Surgery ◽

Sound Amplification ◽

Hearing Outcomes ◽

Residual Air

Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2%) underwent unilateral surgery and 47 (28.8%) underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air–bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6%) ears had a residual air–bone gap <10 dB, and 196 (93.3%) had a residual air–bone gap ≤15 dB. Two patients (0.95%) had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgery may be performed in educational institutions with the supervision of experienced surgeons.

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Association Between the Duration of Hearing Loss and Hearing Outcomes in Surgery for Otosclerosis

Otolaryngology ◽

10.1177/0194599820964726 ◽

2020 ◽

pp. 019459982096472

Author(s):

Alexander L. Luryi ◽

Amy Schettino ◽

Seilesh C. Babu ◽

Dennis I. Bojrab ◽

Elias M. Michaelides ◽

...

Keyword(s):

Hearing Loss ◽

Revision Surgery ◽

Retrospective Review ◽

Primary Outcome ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Stapes Surgery ◽

Complication Rates ◽

Long Duration ◽

Hearing Outcomes

Introduction Hearing loss due to otosclerosis is effectively treated with surgery. The association between duration of hearing loss and surgical outcomes is unknown. Study Design Retrospective review. Setting Large otology referral center. Methods Patients undergoing primary stapes surgery for otosclerosis from 2005 to 2017 were evaluated according to their self-reported duration of hearing loss. Closure of the air-bone gap (ABG) was the primary outcome measure. Results A total of 580 stapes operations were included. Sixteen percent of patients reported hearing loss for ≤1 year; 25%, >1 to ≤5 years; 24%, >5 to ≤10 years; 24%, >10 to ≤20 years; and 12%, >20 years, respectively. Average pre- and postoperative ABGs were 26.1 and 9.6 dB ( P < .0005). Patients with longer duration of hearing loss had worse preoperative ABGs ( P < .0005). After surgery, patients with longer duration of hearing loss had a greater reduction in their ABGs ( P < .0005) such that the remaining ABG was not associated with duration of hearing loss ( P > .05). There were no significant associations between the duration of hearing loss and complication rates or the need for revision surgery. Conclusion Otosclerosis is effectively treated with surgery even after a long duration of hearing loss, provided that sensorineural hearing and word recognition are favorable. Although far-advanced otosclerosis has known poorer hearing outcomes after stapes surgery, a long duration of hearing loss is an unreliable surrogate for this.

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Cerebrospinal Fluid Leak during Stapes Surgery: Gushing Leaks and Oozing Leaks, Two Different Phenomena

Ear Nose & Throat Journal ◽

10.1177/014556131709600817 ◽

2017 ◽

Vol 96 (8) ◽

pp. 302-308 ◽

Cited By ~ 2

Author(s):

Juan Luis Quesada ◽

Giovanni Cammaroto ◽

Lilla Bonanno ◽

Francesco Galletti ◽

Pedro Quesada

Keyword(s):

Cerebrospinal Fluid ◽

Statistical Analysis ◽

Postoperative Complications ◽

Multicenter Study ◽

Cerebrospinal Fluid Leak ◽

Stapes Surgery ◽

Csf Leak ◽

Clinical Evaluations ◽

Hearing Outcomes ◽

Fluid Leak

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients—23 men and 15 women, aged 23 to 71 years (mean: 47)—who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.

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Stapes Surgery in Patients with a Small Air-Bone Gap

Ear Nose & Throat Journal ◽

10.1177/014556131809700709 ◽

2018 ◽

Vol 97 (7) ◽

pp. 198-212 ◽

Cited By ~ 4

Author(s):

Jeremy Lavy ◽

Fiona McClenaghan

Keyword(s):

Outcome Measure ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Primary Outcome Measure ◽

Stapes Surgery ◽

Secondary Outcome ◽

Ktp Laser ◽

Secondary Outcome Measure ◽

Tertiary Center ◽

Hearing Outcomes

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.

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