Does bilateral otosclerosis make pre-operative bone conduction more inaccurate?

Objectives:To assess whether bilateral otosclerosis renders pre-operative bone conduction more inaccurate by increasing the Carhart effect.Methods:Retrospective review of a database of pre and post-operative audiograms of 745 ears with otosclerosis treated with stapedectomy from 2013 to 2020 in a tertiary centre.Main outcome measures:Change in bone conduction after stapedectomy for otosclerosis in:unilateral otosclerosis(U1);bilateral otosclerosis undergoing first side surgery(B1);bilateral otosclerosis undergoing second side surgery(B2).The magnitude of change in bone conduction post-operatively within and between each group.Results:The average difference in pre and post-operative bone conduction was significant within in all groups(T-stat>2 and P-value<0.05)with the greatest change observed in the U1 group.Analysis of average change in bone conduction between groups did not reach statistical significance(Pvalue=0.37).Analysis of change per frequency demonstrated the greatest change in bone conduction post-operatively at 2000 Hz in all groups.The magnitude of change at 2000 Hz was the greatest in the bilateral groups;however,it did not reach statistical significance when compared to the unilateral group(P-value=0.36).Conclusions:This is the first study in the literature to assess the accuracy of pre-operative bone conduction in bilateral versus unilateral otosclerosis.There is no evidence that pre-operative bone conduction in bilateral otosclerosis is more inaccurate than in unilateral disease.In order to assess accuracy of pre-operative bone conduction in otosclerosis a reliable method of assessing post-operative bone conduction is required,without assumption of its equivalence to cochlear reserve.

Revision surgery for otosclerosis:An overview

Stapes surgery for otosclerosis has been proved to be a very satisfying procedure. However, the condition is difficult for the patients with no or little hearing gain after surgery and for those who had sudden or gradual hearing loss after a successful air-bone gap closure in the follow-up period. The issue of re-exploring the middle ear is challenging. A general review of this subject from several points of view remains lacking. In this study, articles related with the revision surgery for otosclerosis have been reviewed after a Pub Med research and common and/or contradictory points were documented. The aim of this study is to give an insight to diagnostic and therapeutic approaches forthe clinicians in patients who need a revision surgery. In conclusion, prosthesis problems, loose prosthesis in stapedotomy and migrated prosthesis in stapedectomy are the most common causes for revision surgery. Most important indicators which effect better hearing outcome following revision surgery are those ears with the presence of incus, with no obliteration of oval window, with small fenestra stapedotomy and the experience of surgeon. The risk of neurosensorial hearing loss in revision cases is not high but the hearing gain is limited as compared to primary cases. The rate of 10 d B air-bone gap closure is around 60%-70% at most and even less promising results have been reported. Patient's demands and expectations have to be clarified in a realistic way.

Preferences in stapes surgery among American otological society otologists

Objective:Stapes surgery is technically challenging,yet its methodology is not standardized.We aim to elucidate preferences in stapes surgery among American Otological Society(AOS)otologists and determine if any common practice patterns exist.Study design:Cross-sectional study via emailed questionnaire.Setting:Surgery centers.Subjects and methods:Members of the AOS were an emailed a survey to quantify variables including surgical volume,anesthetic preference,laser use,type of procedure,footplate sealing technique,antibiotic use,and trainee participation.Results:Most otologists(71%)performed 2 to 5 stapes surgeries per month under general anesthesia(69%)with stapedotomy(71%)as the preferred procedure.Most(56%)used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration.Either the handheld potassium titanyl phosphate(KTP)laser(40%)or handheld carbon dioxide(CO2)laser(33%)was used.The heat-activated memory hook(51%)was the preferred prosthesis.Footplate sealing method was variable,as was antibiotic use among respondents.Trainee participation was limited,as 42%of otologists allowed residents to place the prosthesis,and fewer allowed residents to crimp the prosthesis,and laser or drill the footplate.Surgeons with higher surgical volume(≥6 surgeries per month)demonstrated the following statistically significant correlations:footplate fenestration with laser in a rosette pattern and pick for debris removal(rs=-0.365,P=0.014)and trainee participation with fellows only(rs=0.341,P=0.022).Conclusions:Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.