Stapes Surgery for Otosclerosis in Patients Presenting with Mixed Hearing Loss

Abstract

Objectives: To evaluate the efficacy of stapes surgery in patients presenting with a preoperative mixed hearing loss (bone conduction thresholds ≥40 dB; 40 < air conduction thresholds (AC) < 85 dB). Patients and Methods: A total of 30 patients (32 ears) with mixed hearing loss who underwent primary stapedotomy were evaluated. Audiometric parameters were assessed before and after surgery. Contralateral thresholds were also reported. The need for a hearing aid (HA) after surgery and its impact on quality of life were also measured. Results: AC and word recognition at 40, 55 and 70 dB were significantly improved after stapes surgery. Only 16.6% of the patients needed an HA after surgery and reported being satisfied with the aid. Conclusion: Stapes surgery improved auditory function in patients with mixed hearing loss, allowing most patients to delay the need for an HA without worsening their quality of life.

Insidious Cases of Enlarged Vestibular Aqueduct (EVA) Syndrome Resembling Otosclerosis: Clinical Features for Differential Diagnosis and the Role of High-Resolution Computed Tomography in the Pre-Operative Setting

“…The resemblance to otosclerosis was primarily due to the presence of progressive hearing loss and absent stapedial reflexes in all three patients. Additionally, the mixed hearing loss observed in these patients further complicated the clinical picture, as otosclerosis can also present with mixed hearing loss in advanced stages [ 1 , 17 ]. In a case report published by Távora-Vieira and Miller in 2012, the authors reported that the misdiagnosis and mismanagement of a case of EVA syndrome led to profound hearing loss.…”

“…The presence of acoustic reflexes, VEMP responses, and distortion product otoacoustic emissions (DPOAEs) in some cases further argued against middle-ear disease. CT scans were crucial in the differential diagnosis, showing large vestibular aqueducts in the affected ears without stapedial footplate alterations, which are typically seen in otosclerosis [ 10 , 17 , 18 , 19 ]. As emerges from the cited literature, atypical cases of EVA and otosclerosis can pose a significative diagnostic challenge due to the possibility of overlapping clinical and audiological features (ABGs at low frequencies, same state of stapedial reflexes, and normal middle-ear function), making differential diagnosis challenging [ 1 , 2 , 4 , 5 , 10 , 16 ].…”

“…Therefore, these complications should be actively sought out and identified to prevent stapes surgery before they occur in the contralateral ear [ 2 , 3 ]. Based on the cases presented in the literature, it would be prudent to incorporate pre-operative HRCT of the temporal bones if there is the occurrence of one or more of the following situations: patients with a history of hearing loss since childhood, especially in the absence of a family history of otosclerosis [ 1 , 3 , 11 ]; a low-frequency ABG with supranormal thresholds for bone conduction [ 4 , 8 , 17 ]; the presence of stapedial reflexes [ 4 , 10 ]; suspicious EKG with prolonged QT intervals, as these may indicate genetic cardiac conditions such as a possible Jervell and Lange-Nielsen syndrome, especially if the patient reveals a family history of sudden cardiac death or a personal history of syncopal episodes [ 1 , 12 , 13 ]. In such cases, which can be very variable in their clinical presentations, genetic evaluation should precede the radiological examination of the temporal bones.…”

Stapes Surgery for Otosclerosis: Audiometric and Self-Reported Hearing Outcomes

“…For more than 50 years, treatment of this form of hearing loss relied first on stapedectomy and more recently on stapedotomy (6). High rates of success of otosclerosis treatment using stapes surgery, with long-term stable outcomes, have been demonstrated repeatedly in many studies (7,8). Pure-tone audiometry is the "gold standard" in assessing the effectiveness of stapes surgery.…”