Controversial issues of optimal surgical timing and patient selection in the treatment planning of otosclerosis

Abstract

The aim of this study was to analyze the impact of clinical factors on the outcomes of otosclerosis surgery and support patients' access to evidence-based information in pre-operative counseling to optimize their choices. A total of 109 ears in 93 patients undergoing stapes surgery in a tertiary referral center were included. Variables with a potential impact on hearing outcomes were recorded, with an emphasis on factors that were readily available pre-operatively. Hearing success was defined as a post-operative air-bone gap ≤10 dB. Logistic regression analysis was used to determine the factors independently contributing to the prediction of hearing success. The mean follow-up period was 18.0 months. Univariate and multivariate analyses indicated that none of the pre-operative factors (piston type, age, sex, affected side, tinnitus, vertigo, and pre-operative hearing thresholds) affected hearing success significantly (all p > 0.05). In conclusion, self-crimping Nitinol piston provides comparable hearing outcomes with conventional manual-crimping prostheses. However, Nitinol piston offers a technical simplification of a surgical procedure and an easier surgical choice for patients. In addition, age is not a detriment to hearing gain and instead might result in better use of hearing aids in older adults, thus facilitating social hearing recovery. Finally, hearing success does not depend on the extent of pre-operative hearing loss. Hence, patients with poor cochlear function should not be considered poor candidates for surgery. The predictive model has established recommendations for otologists for better case selection, and factors that are readily available pre-operatively may inform patients more explicitly about expected post-operative audiometric results.

In search of correlation between hand preference and laterality of hearing impairment in patients with otosclerosis

“…The majority of our study patients (218/239, 91.2 %) reported being right handed, a finding in agreement with the studies on hand preferences in different populations [18][19][20][21]28]. Our findings on female prevalence among the patients with otosclerosis, mean age at presentation for stapes surgery and gender differences in handedness were consistent with those in the literature [2,3,[8][9][10][11][28][29][30][31].…”

“…It was found in normal listeners that the right ear (RE) is superior in dichotic listening, monaural speech stimuli, syntax structure, phoneme discrimination, and consonant-vowel recognition [4][5][6][7], whereas,the left ear (LE) is supposed to be superior in nonverbal sound presentation, brief melody listening, and intonation discrimination [4][5][6]. Bilateral otosclerosis (BO) has been reported in 38.9-90 % patients [8][9][10][11][12][13]. The RE advantage in righthanded individuals and the LE advantage in left-handed ones were demonstrated in individuals with a normal hearing and in a population with hearing impairment [14][15][16][17].…”

Stapes Surgery for Otosclerosis in Patients Presenting with Mixed Hearing Loss

“…In our study, hearing success did not depend on the extent of preoperative hearing loss. Consistent with a report by Shiao in 2013 [Shiao et al, 2014], we confirm that patients with poor cochlear function should not be considered poor candidates for surgery.…”

A systematic review of the effect of different crimping techniques in stapes surgery for otosclerosis

“…; date of last search was April 6, 2015). We included 22 articles after selection based on title and abstract and subsequent full text screening . No articles were excluded based on language, nor were any articles excluded because we could not retrieve the full‐text version.…”

“…This article was not retrieved in our initial search because it is not indexed in PubMed, EMBASE, or the Cochrane Library. This article reported hearing results in the same study population as one of the articles that was retrieved through our search strategy . Data were extracted from both articles, but the two articles were regarded as one study in our study assessment and evaluation of hearing results.…”