Decision making in advanced otosclerosis: An Evidence-Based Strategy

Merkus, Paul; Loon, Maarten C. van; Smit, Conrad F.; Smits, Cas; Cock, Adrianus F. C. de; Hensen, Erik F.

doi:10.1002/lary.21904

Cited by 52 publications

(81 citation statements)

References 27 publications

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“…If, HRCT shows extensive retrofenestral otosclerosis (Rotteveel grade 2C or 3), CI should be recommended. 3 Stapedotomy with subsequent hearing aid use is a useful treatment option for patients with good speech discrimination. 46%-100% hearing improvement has been reported after stapedotomy.…”

Section: Discussionmentioning

confidence: 99%

Management of advanced otosclerosis: experience in a tertiary care centre

Alam¹,

Natarajan

Singh

et al. 2018

Int J Otorhinolaryngol Head Neck Surg

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Background: Advanced otosclerosis affects approximately 10% of patients with otosclerosis. Ossification of the cochlea increases with the course of the disease and may cause sensori-neural or mixed hearing loss. Hearing aids, stapedotomy and cochlear implants are management options for hearing loss associated with advanced otosclerosis. Methods: A retrospective study of 153 patients with advanced otosclerosis was done in a tertiary ENT centre. 110 patients with advanced otosclerosis underwent stapedotomy and 43 patients with advanced otosclerosis underwent cochlear implantation (CI) from 1997 till date. Exclusion criteria included patients with profound hearing loss from causes other than otosclerosis. The aim was to study the indications, selection criteria, as well as surgical issues of stapedotomy and cochlear implantation in patients with advanced otosclerosis. Results: Stapedotomy followed by use of hearing aid was found to give good outcomes in advanced otosclerosis. Patients with advanced otosclerosis who had poor pre-operative speech discrimination underwent CI. Complete insertion was possible in 39 patients and partial insertion was done in 4 patients. The outcomes of cochlear implantation were found to be satisfactory. Facial nerve stimulation was seen in 5 patients who underwent CI; however this was successfully managed by reprogramming or switching off the concerned electrodes. Conclusions: In our experience, stapedotomy or CI in advanced otosclerosis has proven successful, with a low complication rate. The selection criteria for stapedotomy versus CI have to be stringent for optimal outcomes.

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Section: Discussionmentioning

confidence: 99%

Management of advanced otosclerosis: experience in a tertiary care centre

Alam¹,

Natarajan

Singh

et al. 2018

Int J Otorhinolaryngol Head Neck Surg

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“…Results shown in this study, based on PTA, indicate that CI implanted in an ear with P-SNHL is an effective, safe measure to provide stable audibility from the first month of activation. This piece of information is extremely important for the group of patients with AHL because an objective of bimodal adaptations is to obtain better sound perception and ensure hearing through one of the ears, in case the contralateral ear may suffer some type of degenerative pathology, as could potentially be the case with bilateral Meniere's disease [15] , autoimmune hearing loss [16] , otoesclerosis [17] , or some labyrinth malformations [18] . The stable PTA results had already been described by other authors [19,20] , and their homogeneity, regardless of the initial HLs, can be explained by several reasons: 1.)…”

Section: Discussionmentioning

confidence: 99%

Bimodal Stimulation with Cochlear Implant and Hearing Aid in Cases of Highly Asymmetrical Hearing Loss

Sanhueza

Manrique²,

Huarte³

et al. 2016

Int Adv Otol

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“…It occurs mainly around the oval window (the fenestral otosclerosis) and, in 10 % of patients, in the peri-cochlear location of the otic capsule (the retrofenestral otosclerosis) [22]. The mainstay of treatment for patients with otosclerosis is a stapedotomy.…”

Section: Associated Acquired Abnormalities Of the Temporal Bonementioning

confidence: 99%

Role of HRCT and MRI of the Temporal Bone in Predicting and Grading the Degree of Difficulty of Cochlear Implant Surgery

Vaid

Vaid²,

Manoj³

et al. 2015

Indian J Otolaryngol Head Neck Surg

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This study proposes a grading system based on a 10-point scoring chart of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) imaging findings in patients being assessed preoperatively for cochlear implantation. This system helps in objectively assessing the degree of difficulty of the surgical procedure and alerts the surgeons to any potential intraoperative complications. This is a prospective study carried out at a tertiary referral center where 55 patients with bilateral profound sensorineural hearing loss were evaluated by HRCT and MRI and subsequently underwent cochlear implantation. HRCT examinations were performed on a 64 slice multidetector CT scanner. MRI examinations were performed on a 3.0 Tesla MRI scanner. A 10-point scoring chart was devised based on specific imaging findings and all patients were assigned potential difficulty scores (PDS) based on HRCT and MRI findings. Surgical times were documented in each case and each imaging point on the scoring chart was correlated with the surgical times. Eight out of theó ten points in the scoring chart proved to be statistically significant in predicting the degree of difficulty of the surgical procedure. After grading the pre-operative imaging examinations based on the 10-point scoring chart we concluded that patients who have PDS between 0 and 3 (Grade 1) have uneventful and uncomplicated surgery with the lowest intraoperative times. Patients with PDS between 4 and 7 alert the surgeon to moderate surgical difficulty and longer intraoperative times. PDS of 8 and above indicate prolonged and difficult surgery.

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Decision making in advanced otosclerosis: An Evidence-Based Strategy

Abstract: To achieve optimal hearing with minimal disadvantages in patients with otosclerosis and severe to profound hearing loss, an algorithm can help in the selection of patients for either cochlear implantation, stapedotomy, or hearing aids and follow-up.

Cited by 52 publications

References 27 publications

Management of advanced otosclerosis: experience in a tertiary care centre

Management of advanced otosclerosis: experience in a tertiary care centre

Bimodal Stimulation with Cochlear Implant and Hearing Aid in Cases of Highly Asymmetrical Hearing Loss

Role of HRCT and MRI of the Temporal Bone in Predicting and Grading the Degree of Difficulty of Cochlear Implant Surgery

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