Stapedial surgery in otosclerosis: analysis of results and prognostic factors

Abstract

Otosclerosis corresponds to a localized disorder of bone metabolism, which develops in the otic capsule. It is responsible for the development of conductive hearing loss, with stapedial surgery being considered the gold standard therapeutic intervention. The goal of the present study was to evaluate the outcomes of stapedial surgery, aiming to identify prognostic factors. A descriptive, cross-sectional, and retrospective study was designed and conducted on a cohort of patients with a diagnosis of otosclerosis (N=98). The following variables were analyzed: age at the time of surgery, sex, bilaterality of disease, presence of Carhart's notch, type of prosthetic material used, presence of anatomical variations, intraoperative complications, audiometric results, and functional success. The overall rate of functional success (defined as an average air-bone gap < 15 dBHL) was 89.80% (n = 88). Regarding audiometric results, air conduction thresholds (PTA 500, 1000, 2000, and 4000 Hz) improved from 55.14 ± 1.42 to 32.00 ± 2.01 dBHL (p < 0.001, paired t-test), and bone conduction thresholds (PTA 500, 1000, 2000, and 4000 Hz) changed from 25.98 ± 1.07 to 24.09 ± 1.33 dBHL (p = 0.270, paired t-test) between preoperative and postoperative values. The air-bone gap decreased from 29.16 ± 0.79 to 7.91 ± 0.88 dBHL (p < 0.001, paired t-test) between the preoperative and postoperative periods. In our study, the only variable that significantly influenced the primary outcome (functional success) was the presence of anatomical variations and/or intraoperative complications, which were negatively correlated with functional success. Stapedotomy/stapedectomy is an effective procedure with high rates of functional success. The presence of anatomical variations and/or intraoperative complications is a predictor of lower audiometric gain and less surgical success.