Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis

Abstract

Cochlear implantation leads to a statistically greater and consistent improvement in speech recognition scores. Stapedotomy is not universally effective; however, it yields good results comparable to cochlear implantations in at least half of patients. For cases of unsuccessful stapedotomy, the option of cochlear implantation is still open, and the results obtained through salvage cochlear implantation are as good as those of primary cochlear implantation.

Stapes Surgery for Profound Hearing Loss Secondary to Otosclerosis

“…Unlike CI, stapes surgery does not require extrusive rehabilitation and avoids the need to change quality and tonality of sound. 10 As other studies have suggested, our findings show that some patients respond very well to stapes surgery, while for a minority, the results are unsatisfactory. In most cases, hearing thresholds are improved to a level where hearing aids are of benefit, and in 80% of patients, their thresholds improved to move them out of the category of ''profound'' hearing loss, so they would be no longer eligible for CI.…”

“…We also hope it will contribute to future meta-analyses, increasing the evidence available; the 2 published meta-analyses looking at this clinical question contain 4 and 9 articles, respectively. 10,22 These studies show that CI is more likely to improve hearing to a good standard overall, but that when stapes surgery is effective, it produces hearing that is nearly equivalent. 7,10,19,22 As yet, there is no complete consensus on the preoperative factors that can predict successful stapes surgery, although variables such as word recognition scores, benefit derived from hearing aid use, and extent of retrofenestral sclerosis have been suggested.…”

“…[2][3][4] However, there is also much evidence to suggest that stapes surgery can restore hearing to acceptable levels in patients with similar ''profound'' hearing loss, especially when combined with a well-fitted hearing aid. [5][6][7][8][9][10] Furthermore, whereas CI can be time-consuming and physically invasive, stapes surgery is minimally invasive and cost-effective. If stapes surgery is not beneficial, CI or revision stapes surgery can be performed.…”

Cochlear implantation in far-advanced otosclerosis: hearing results and complications

“…As shown in several studies describing hearing improvement after stapedotomy in patients with severe to profound hearing loss, stapedotomy combined with hearing aids does not lead to many complications, and is relatively low cost, efficient and effective (post-operative disyllabic WRS at 60 dB = 50.6% for Kabbara et al) 9 . Moreover, stapes surgery does not preclude further cochlear implantation 4 9 10 .…”

Highlights from the Current Issue

“…2 After an extensive review of the literature, the authors identified 4 relevant papers that met their inclusion criteria. From their analysis, the authors concluded that cochlear implantation leads to significantly better speech recognition scores than stapedotomy; however, they noted significant variation in outcomes following stapedotomy.…”