Far Advanced Otosclerosis: Stapes Surgery or Cochlear Implantation?

Stapedotomy in Cochlear Implant Candidates With Far Advanced Otosclerosis

“…Lachance et al (6) used an open-set sentence recognition test and reported the highest postoperative speech recognition score. This positive finding might be an overestimation as compared with other studies because patients generally score better when tested with sentences instead of words (3,13). All other studies used words for speech recognition testing; unfortunately, the exact method of testing is often unclear.…”

“…Both Berrettini et al (13,18) and Calmels et al (13,18) demonstrated that CI leads to statistically better mean speech recognition scores than stapedotomy when the whole group of CI patients was compared with the whole group of stapedotomy patients. However, stapedotomy yielded excellent results in a considerable subgroup (in four of six and four of seven of the patients).…”

“…The majority of patients included in this meta-analysis however received a unilateral stapedotomy only (64 of 89 patients). As similar surgical outcomes and chances of improving speech recognition can be expected in the contralateral ear, bilateral stapedotomy would further increase the number of patients with good audiologic performance (13). In addition, the postoperative outcome in this analysis is often based on the best performing ear only.…”

“…If unilateral stapedotomy does not result in a satisfactory outcome, a contralateral stapedotomy can be performed because the chance of success in the contralateral ear is not influenced by the previous stapedotomy. If the first stapedotomy was successful, a consecutive contralateral stapedotomy can offer patients the benefits of binaural processing (13). When (bilateral) stapedotomy does not yield a satisfactory result, the option of CI is still open because a previous ipsilateral stapedotomy will not affect the outcome or performance of CI (3,7,8).…”

Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis

“…However, the results of stapedotomy for advanced otosclerosis in the included studies were quite variable-''very good in some cases but unsatisfactory in others.'' 21 The overall success rate of stapedotomy in this systematic review is 55%, and in the general literature, the reported success rates range between 36% and 89%. 13,23 Unlike the variable outcomes of stapedotomy, CI in patients with advanced otosclerosis consistently yields excellent results with regard to speech recognition.…”