Predictors of hearing outcomes after stapes surgery in otosclerosis

Abstract

Background: The current surgical treatment of otosclerosis is stapes surgery; however, few studies have reported the predictors of surgical outcomes.

Aim/objective: This study aimed to investigate the prognostic predictors for postoperative hearing outcomes.

Materials and methods: A total of 181 ears in 152 patients undergoing stapes surgery at a tertiary referral centre in Taiwan from 1996 to 2016 were retrospectively enrolled and preoperative and intraoperative parameters were obtained. Univariate and multivariate analyses were used to determine independent predictors of postoperative hearing outcomes. A regression model was also established. Hearing success was defined as a postoperative air-bone gap (ABG) ≤10?dB.

Results: In univariate analysis, the absence of floating footplate during surgery (p?=?.003) and small preoperative ABG (p?=?.014) were associated with successful hearing outcomes. Multivariate logistic regression analysis further revealed the absence of floating footplate during surgery (p?=?.010) and small preoperative ABG (p?=?.015) remained independent predictors of postoperative hearing success.

Conclusions and significance: Preoperative audiometric data and intraoperative finding may provide surgeons and patients with a better insight into surgical outcomes.     

Factors affecting hearing results after stapes surgery.

Factors affecting auditory improvement after stapes surgery were investigated retrospectively on a study group of 106 otosclerotic ears (86 subjects). While the closure of the air-bone (A-B) gap after surgery was good at 2 kHz and 4 kHz, it was poor at 8 kHz and at frequencies lower than 1 kHz. Under 1 kHz, the lower the frequency, the worse the A-B gap after surgery. Stapedotomy and partial stapedectomy showed better post-operative hearing gain at 4 kHz than total stapedectomy. Total stapedectomy scored significantly better at 250 Hz and 500 Hz than stapedotomy. There was a close relationship between the pre-operative and post-operative A-B gap at frequencies under 1 kHz. The smaller the pre-operative A-B gap, the better the closure of the post-operative A-B gap at these frequencies. It was speculated that otosclerotic ears with a larger pre-operative airbone gap might have another lesion in the middle ear other than the oval window.     

Long-term outcomes of stapes surgery

ObjectiveHearing improvement following stapes surgery is generally good; however, we sometimes encounter patients where hearing loss gradually progresses over the long term. In this study, we investigated the causes of hearing loss in these cases.MethodsA total of 30 ears from 23 patients, who underwent stapes surgery at Kitasato University Hospital from 2001 to 2021 and were followed up for ≥5 years, were included in the study. Changes in air conduction (AC) and bone conduction (BC) thresholds were measured, and hearing evaluation was performed by calculating the air–bone gap (ABG) at the mean of 4 frequencies. Cases with a postoperative ABG of ≤10 dB at 6 months after surgery were classified into the following groups according to their hearing changes at 5 years after surgery: Group A (no ABG increase of ≥10 dB and no AC threshold increase of ≥10 dB) and Group B (an ABG increase of ≥10 dB and an AC threshold increase of ≥10 dB). In groups A and B, we examined factors affecting long-term postoperative results. In addition, the patients who underwent reoperation were examined.ResultsThe AC thresholds 6 months and 5 years after surgery decreased significantly compared with those before surgery (p < 0.01); however, the BC thresholds 6 months and 5 years after surgery did not vary significantly from those before surgery (p > 0.05). Group A included 16 ears from 13 patients (53.3%), and Group B included 3 ears from 3 patients (10.0%). There were no significant differences in age, sex, surgical method, piston type, piston length, presence of incudostapedial joint subluxation, computed tomography findings, and preoperative ABGs between groups A and B (p > 0.05). A total of 6 reoperations were performed in 3 ears from 3 patients, and there were 5 operations with the platinotomy hole to be closed by bone regrowth and 3 operations with the narrowed long process of the incus.ConclusionIn 10.0% of the patients who underwent stapes surgery, the ABG improved 6 months after surgery; however, the AC threshold and ABG increased 5 years after surgery. Our findings suggested that piston displacement and the platinotomy hole to be closed by bone regrowth are possible causes of hearing loss in cases where hearing loss progresses in the long term after stapes surgery.     

High frequency hearing following stapes surgery

Abstract Conclusion: Our results indicate that a pre-existing sensorineural hearing loss (SNHL) is not a potential risk factor for further hearing loss in stapes surgery. Objective: The study evaluated whether pre-existing SNHL in otosclerosis constitutes a risk factor for further hearing loss in stapedotomy. Methods: Preoperative and postoperative audiometric evaluation including air (AC) and bone conduction (BC) hearing levels were assessed together with collection of surgical records from 338 consecutively operated cases for primary otosclerosis using a database. Patients were operated by the same surgeon between 2000 and 2006. In all, 291 patients were operated on 1 side and 47 patients were operated on both sides. Ages ranged from 16 to 76 years. Stapedotomy was performed in all cases except five (stapedectomy). Cases were separated into four different groups based on preoperative AC hearing levels at 4, 6, and 8 kHz: group I, <30 dB HL; group II, 30-50 dB HL; group III, 51-70 dB HL; group IV, >70 dB HL). Results: Hearing deterioration at 4, 6, and 8 kHz (>10 dB) was observed in 6.5% of all cases. Patients with normal preoperative hearing were found to be more prone to further SNHL 4, 6, and 8 kHz (range 13-25 dB) at surgery, while patients in group IV, with preoperative SNHL impairment, remained unaffected.     

Frequency-specific hearing results after stapes surgery for Chinese population otosclerosis with different degrees of hearing loss

Abstract

Background: Frequency-specific hearing studies are important for predicting hearing results and the prognosis after stapes surgery, to prepare for the rehabilitation of frequency-specific hearing in patients with otosclerosis.

Objectives: To evaluate outcomes of stapes surgery of Chinese otosclerosis patients with different degrees of hearing loss.

Methods: We conducted a retrospective analysis of 213 otosclerosis patients who underwent stapes surgery in our hospital. Pre- and post-operative audiometric evaluation using conventional audiometry.

Results: The post-op ABG was less than 20?dB in 94.52% of all cases after surgery. There was no statistical significance of the post-op ABG among different groups at all frequencies except extremely severe group (p?<?.05). There was a significant improvement of both AC and BC thresholds in post-op period and the most significant improvement was found in severe group. There were no serious post-op complications and no re-operations during the follow-up period.

Conclusion: Stapes surgery is a suitable treatment option for otosclerosis with mild to extremely severe HL. The mild to moderate hearing loss groups had the most significant improvement of AC thresholds in the low frequency region, and the severe to extremely severe groups appeared in the high frequency region.     

Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery

The predictive value of olfaction for quality of life (QoL) recovery after endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) is still underestimated. The aim of this study was to explore the proportion of patients suffering from CRS who experience clinically significant QoL improvement after ESS and identify pre-operative clinical phenotypes that best predict surgical outcomes for QoL, focusing mainly on the role of patients’ olfaction. One hundred eleven patients following ESS for CRS and 48 healthy subjects were studied. Olfactory function was expressed by the combined “Threshold Discrimination Identification” score using “Sniffin’ sticks” test pre-treatment and 12 months after treatment. All subjects completed validated, widely used QoL questionnaires, specific for olfaction (Questionnaire of Olfactory Deficits: QOD), for assessing psychology (Beck Depression Inventory: BDI) and for general health (Short Form-36: SF-36). Statistically significant improvement of olfactory function by 41.8 % and of all QoL questionnaires scores (all p < 0.001) was observed on the 12-month follow-up examination. Clinically significant improvement for QoL was measured in a proportion of 56.8 % of patients on QOD, 64.9 % on SF-36 and 49.5 % on BDI scales results. Although olfactory dysfunction, nasal polyps, female gender, high socio-economic status and non-smoking habits were significantly associated with better QoL results, multivariate logistic regression analysis revealed that only olfactory dysfunction and nasal polyps were independent predictors significantly associated with higher likelihood of clinically significant improvement in all QoL questionnaire results. Olfactory dysfunction and nasal polyps were independent pre-operative predictors for surgical outcomes with regard to QoL results.     

Delayed vertigo after stapes surgery

OBJECTIVES: Stapes surgery restores partial or total hearing in almost 95% of cases, and in case of failure, revision surgery may often resolve the problem. Delayed vertigo is commonly related to perilymphatic fistula. The aim of this study is to report experience gained in revision stapes surgery in cases of delayed vertigo. STUDY DESIGN: This is an intervention study, before-after trial; it includes follow-up between 12 and 84 months that was based on clinical history and audiometric evaluations. METHODS: The work was carried out in the otologic surgery referral center of Piemonte in outpatient surgery. Nine patients (4 males and 5 females, between 43 and 60 years of age) who presented with delayed vertigo after stapes surgery were retrospectively reviewed. All nine underwent clinical history evaluation, pure tone audiogram, investigation of the vestibular system with a bithermal binaural caloric test, and fistula test. Vestibular tests were performed with electronystagmography recording. In all nine subjects, functional middle ear exploration was carried out by way of a transmeatal approach using local anesthesia. The demonstration of a perilymphatic leak was positive in only three (33%) cases, but the oval window region was filled with fibrin glue in all nine cases. RESULTS: At follow-up, vertigo was resolved in all cases with revision surgery, even though perilymph leak was positive only in three cases. CONCLUSION: From the results obtained, we feel that exploration of the middle ear should be always carried out in cases of delayed vertigo after stapes surgery with suspected perilymphatic fistula.     

Taste function after stapes surgery

Objective

A manipulation of chorda tympani nerve (CTN) is frequently necessary during the surgical therapy of stapedial ankylosis. The aim of this study was to re-assess the taste function before and after stapes surgery in patients with unilateral stapes ankylosis.

Methods

Eighteen patients (14 female and 4 male) with unilateral stapedial ankylosis were included. Taste and olfactory function were measured preoperatively, 3 days and 3 months after surgery by questionnaire, chemical taste test, electrogustometry, and Sniffin'Sticks. The patients who reported deterioration in taste and revealed pathological taste test results were re-investigated 8–12 months after surgery. Postoperatively 11 patients were treated intravenously for 3 days for inner ear protection with 1 g of cortisone. The gustatory and olfactory results were compared with age and sex specific normative data.

Results

A significant transient decrease of gustatory measurement values was found on the ipsilateral two thirds of the anterior tongue. 12 out of 17 patients whose CTN was slightly manipulated during stapes surgery reported tongue sensations, such as numbness or gustatory blindness of the ipsilateral tongue side. The measures of chemical taste test significantly decrease in lateralized taste test on the ipsilateral side and in whole mouth testing. There was no significant increase of the EGM measures at the ipslateral tongue. In 11 of 12 patients with symptoms, complaints recovered within one year after surgery completely. The factor “cortisone” did not have a significant effect on the taste test results after surgery.

Conclusion

In conclusion, even after minor CTN manipulation the rate of postoperative taste disorders or tongue symptoms after stapes surgery is high. The symptoms appear to be transient. Therefore CTN should be preserved in stapes surgery after mild trauma of the CTN. Transient taste alteration should be mentioned prior to stapes surgery.     

Technical and functional hearing results after unilateral stapes surgery for otosclerosis at Cluj-Napoca University Hospital

The aim of this study was to assess the hearing results after unilateral stapes surgery for otosclerosis at Cluj-Napoca University Hospital, and to evaluate surgical trauma to the inner ear in these patients. The medical records of 387 consecutive patients who underwent unilateral stapes surgery were reviewed. Hearing results were evaluated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium guidelines and the Glasgow benefit plot. In addition we used Amsterdam plot to give an overview on air conduction gain and bone-conduction differences on an individual level. Results were analyzed separately for patients with preoperative unilateral, bilateral asymmetrical, and bilateral symmetrical hearing loss. Despite good technical hearing results after surgery (closure of the air-bone gap to ≤20 dB in 92 % of patients, air conduction gain of 24 ± 10.00 dB), only 37 % of patients achieved functionally normal, symmetrical hearing. Our results indicated that the pattern of preoperative hearing impairment in patients with otosclerosis can predict postoperative functional hearing results. The type of preoperative hearing impairment had.     

Role of stapes surgery in improving hearing loss caused by otosclerosis

The aim of our study was to evaluate the functional results of stapes surgery and to compare the effectiveness of small fenestra stapedotomy with that of total stapedectomy in improving hearing in patients affected by otosclerosis. Three hundred and fifty-seven consecutive ears, in 265 patients affected by otosclerosis, underwent surgery. All cases underwent either primary small fenestra stapedotomy (group A, 196/357, 54.91 per cent) or stapedectomy (group B, 161/357, 45.09 per cent). After surgery, 256/357 (71.71 per cent) cases showed a 0-20 dB gap. There were no significant differences in hearing results between the two groups at either early or late post-operative assessment. The mean post-operative pure tone average and air-bone gap results were slightly greater for group B than for group A, at both early and late post-operative assessments, but these differences were not statistically significant. Therefore, in group A, the mean pure tone average at 4 kHz significantly improved, from 56.60 to 47.66 dB at early post-operative assessment and to 52.98 dB at late post-operative assessment. Our study suggests that the technique of microtomy of the oval window is able to improve hearing results especially at high frequencies.     

Long-term results after stapes surgery for otosclerosis

In a retrospective study, hearing results before and after stapedectomy were compared with those of individuals not undergoing surgery. Subjects were 51 patients who were surgically diagnosed as having otosclerosis and who could be followed up for more than 5 years. Of these, 31 contralateral ears surgically diagnosed as otosclerotic did not undergo surgery (nonsurgery group). Nineteen ears underwent stapedectomy using a wire loop prosthesis (TS group). Thirty-eight ears underwent stapedotomy using a wire piston prosthesis (SFS group). In the nonsurgery ear group, the last air conduction threshold deteriorated equally at all frequencies. Deterioration of the high frequency air conduction threshold seemed to cause deterioration of the bone conduction threshold. Deterioration of the last air conduction threshold in the SFS group was somewhat less than that in the TS group, although not significantly. In patients up to 50 years old, the air conduction loss/year in the SFS group was significantly less than that in the nonsurgery ear group at 0.25 kHz and 0.5 kHz. The bone conduction loss/year in the SFS group was less than that in both the TS group and nonsurgery ear group at 1 kHz. No significant differences was seen in either air or bone conduction loss/year among the 3 groups in patients 51 years or older. We concluded that stapedotomy and wire piston prosthesis are the surgical techniques of choice in the treatment of otosclerosis.     

Improvement of bone conduction after stapes surgery in otosclerosis patients with mixed hearing loss depending from surgical technique

This study investigate the effect of stapes surgery on bone conduction (BC) improvement in otosclerotic patients with mixed hearing loss and also compare the effect of three different types of surgery (complete stapedectomy, partial stapedectomy and microfenestration stapedotomy) on this improvement. We retrospectively reviewed surgical database of 84 otosclerotic patients with mixed hearing loss. Sixty-two patients (75%) had significant improvement in BC after surgery (P = 0.03). In 85% of patients with follow-up time longer than 1 year, this improvement had remained. Improvement in BC after surgery was better in partial stapedectomy group (82.6%) and complete stapedectomy group (80.8%) in comparison with microfenestration stapedotomy group (63%) (P = 0.052).