|Year : 2019 | Volume
| Issue : 3 | Page : 114-116
Outcome of hearing in stapedectomy versus stapedotomy in nonendemic areas
Ahmad Alroqi, Mohammad Alshahrani
Department of Otolaryngology, King Abdulaziz University Hospital, Riyadh, Saudi Arabia
|Date of Submission||22-Feb-2019|
|Date of Acceptance||13-Jul-2019|
|Date of Web Publication||18-Oct-2019|
Dr. Ahmad Alroqi
Department of Otolaryngology, King Saud University, King Abdulaziz University Hospital, Riyadh, 11411
Source of Support: None, Conflict of Interest: None
Background and Objectives: Stapedectomy and stapedotomy are the standard techniques for surgical treatment of stapes fixation. Both techniques differ in the size of the created opening in the stapes footplate and the type of prosthesis used. The aim of the study is to evaluate the outcomes of hearing following the two surgical techniques. Methods: One hundred and forty-nine medical records of patients who underwent stapedectomy or stapedotomy between the years 1988 and 2011 were reviewed. The subjects were classified into two groups including stapedectomy and stapedotomy. The clinical and immediate pre- and postoperative air-conduction (AC) threshold, bone conduction, and air-bone gap (ABG) were compared between the two groups. Results: The average age of patients included (n = 149) was 34.4 years at the time of surgery. The pure-tone average calculated for AC for clinical and immediate preoperative and postoperative was 57.6, 58.9, and 35.3 dB, respectively. The ABG calculated for clinical, immediate preoperative, and postoperative was 37, 36.9, and 14.5 dB, respectively. The majority of the patients (80.5%) underwent surgery for otosclerosis. Stapedectomies were done for 60.4% versus 39.6% stapedotomies. Preoperatively, the majority of patients fall within the class of moderate to moderate-severe hearing loss. Closure of ABG to 10 dB or more was achieved in 50.4% of the cases. Postoperative ABG was statistically different (P = 0.002) between the stapedectomy (16.79 dB) versus stapedotomy (10.85 dB) group. Conclusions: Stapedotomy cases were better than stapedectomy ones in closing the ABG. The frequency (250 Hz) AC threshold was better in the stapedotomy group compared to the stapedectomy one in a postoperative audiogram. No statistical difference was observed between the two groups in the other frequencies.
Keywords: Hearing, stapedectomy, stapedotomy, stapes
|How to cite this article:|
Alroqi A, Alshahrani M. Outcome of hearing in stapedectomy versus stapedotomy in nonendemic areas. Indian J Otol 2019;25:114-6
| Introduction|| |
Stapes surgery had evolved as an option for a patient with stapes fixation. Techniques have been described and practiced over years with the literature rich of advantages and disadvantages of different techniques. Stapes fixation can be caused by otosclerosis, tympanosclerosis, and congenital stapes fixation. Stapedectomy surgery was introduced by John Shea in 1956 when he developed an appropriate prosthesis.
Our aim in this study is to compare the hearing outcome between the stapedectomy and stapedotomy groups.
| Methods|| |
The study was carried out in a reference hospital (university hospital) where cases are referred from different regions within Saudi Arabia. One hundred and forty-nine medical records of patients who underwent stapedectomy or stapedotomy between the years 1988 and 2011 were reviewed. The subjects were classified into two groups including stapedectomy and stapedotomy. The data collected for every patient included age at the time of surgery, gender, diagnosis, and three audiograms (the first one done in the clinical audiogram, preoperative audiogram, and postoperative audiogram). Air-conduction (AC) thresholds for the frequencies at 250, 500, 1000, 2000, 4000, and 8000 Hz were recorded. Bone-conduction (BC) thresholds for the frequencies at 500, 1000, 2000, and 4000 Hz were recorded. The pure-tone average (PTA) was calculated by taking the average of the AC frequencies at 500, 1000, and 2000 Hz. The patient's hearing was classified according to the PTA as follows: (normal: <25, mild: 25–40, moderate: 40.1–55, moderate-severe: 55.1–70, severe: 70.1–90, and profound: >90). The air-bone gap (ABG) was calculated by subtracting the average of the BC frequencies at 500, 1000, 2000, and 4000 Hz from the average of the AC frequencies at 500, 1000, 2000, and 4000 Hz. The two groups were tested for difference in data collected. SPSS version 19.0 (IBM Corp., Armonk, NY) was used for the analysis of our data.
Stapes surgeries were done by different surgeons. All stapes surgeries except for two were done under general anesthesia. 83.8% of the patients were Saudi.
| Results|| |
The average age of our patients was 34.4 years (range between 14.4 and 60.9 years). We have a significant difference in age between the two groups [Table 1]. The average frequencies of the AC and BC for the three audiograms are shown in [Figure 1] and [Figure 2]. Males represent 53% (n = 79/149). The patients who did the surgery as the first ear represent 73.8%. The diagnoses were otosclerosis, tympanosclerosis, and congenital stapes fixation in 80.5%, 18.8%, and 0.7% respectively. The disease was bilateral in 91.3% of the patients. Stapedectomies were done for 60.4% (n = 90) versus 39.6% (n = 59) stapedotomies. The hearing classifications in the audiograms obtained are shown in [Table 2]. The majority of patients hearing were in the class of moderate to moderate-severe in the preoperative audiogram. Closure of ABG to 10 dB or more was achieved in 50.4% [Table 3]. ABG for stapedectomy was 37.3, 37.9, and 16.8 dB at clinical, preoperative, and postoperative audiograms, respectively. ABG for stapedotomy was 36.6, 35.3, and 10.8 dB at clinical, preoperative, and postoperative audiograms, respectively. Statistical difference between the two groups (P < 0.05) was found in age; AC threshold frequencies at 1000, 2000, and 8000 Hz at clinical visit; BC threshold frequencies at 500, 1000, and 4000 Hz at clinical visit; BC threshold frequencies at 500 and 1000 Hz at preoperative visit; AC threshold frequency at 250 Hz at postoperative visit; and BC threshold frequencies at 500 and 1000 Hz at postoperative visit. The postoperative ABG was statistically different between the two groups [Table 1].
| Discussion|| |
Otosclerosis is the cause of 5%–9% of the cases with hearing loss and of 18%–22% of conductive hearing loss., The disease is bilateral in 70%–80% of patients, and the symptoms occur depending on the site of the otosclerotic focus. In Asian countries, the incidences of clinical otosclerosis are much lower and approximately zero in blacks, with a few exceptions in natives globally.
Tympanosclerosis is a general term that indicates irreversible calcification in the middle ear, developing as a sequela of otitis media. Tympanosclerosis may involve the ossicular chain causing conductive or mixed hearing loss necessitating surgical removal and ossicular chain reconstruction.
Shea's stapedectomy was accepted as a standard operation for otosclerosis by all otologists. It was modified in the size of window opening (total, partial stapedectomy, and small-hole stapedotomy) and the type of prosthesis used.
The outcome of stapes surgery was considered successful if the closure of ABG was within 10 dB. Most authors found that stapedotomy was superior to stapedectomy in terms of restoration of high-frequency hearing gain and reduction of inner ear injury.
In a retrospective study done by Kisilevsky et al., the success of stapedotomy was achieved in 82% of the cases. Stapedotomy, or small fenestra stapes surgery, offers several advantages over total stapedectomy, including less postoperative vertigo and better closure of the ABG at higher frequencies. Stapedectomy has been shown to result in better gain in the low frequencies., In our analysis, we show better gain in the low frequency (250 Hz) in the stapedotomy group.
In our series, we showed postoperative ABG difference between the two groups in favor to stapedotomy. Postoperative BC threshold was different between stapedectomy and stapedotomy; however, it remains within the normal audiometric range in both the groups. We have statistical differences between the groups that could affect our outcome in the age and certain frequencies in the two audiograms (clinical and preoperative). Running a randomized clinical trial might eliminate the bias encountered.
| Conclusion|| |
We conclude that closure of the ABG in the stapedotomy was superior to the stapedectomy with better gain in frequency (250 Hz). Longer term results may or may not show the same results.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Glasscock ME, Shambaugh GE Jr., editors. Diagnosis, indications for surgery, and medical threapy of otospongiosis and operation for otospongiosis. Surgery of the Ear. 4th
ed. Philadelphia: W.B. Saunders; 1990. p. 371-418.
Shea JJ Jr. Fenestration of the oval window. Ann Otol Rhinol Laryngol 1958;67:932-51.
Chole RA, McKenna M. Pathophysiology of otosclerosis. Otol Neurotol 2001;22:249-57.
Iyer PV, Gristwood RE. Histopathology of the stapes in otosclerosis. Pathology 1984;16:30-8.
Cummings C. Otolaryngology-Head and Neck Surgery. Philadelphia, PA: Mosby; 1999. p. 535-8.
Kapur YP, Patt AJ. Otosclerosis in South India. Acta Otolaryngol 1966;61:353-60.
Zollner F. Tympanosclerosis. J Laryngol Otol 1956;70:77-85.
Teufert KB, De La Cruz A. Tympanosclerosis: Long-term hearing results after ossicular reconstruction. Otolaryngol Head Neck Surg 2002;126:264-72.
Thamjarayakul T, Supiyaphun P, Snidvongs K. Stapes fixation surgery: Stapedectomy versus stapedotomy. Asian Biomed 2010;4:429-34.
Mangham CA Jr., Neel J, Mangham HF. Success of five stapes prostheses evaluated by Kaplan-Meier product-survival procedure. Otol Neurotol 2008;29:900-4.
Kisilevsky VE, Dutt SN, Bailie NA, Halik JJ. Hearing results of 1145 stapedotomies evaluated with Amsterdam hearing evaluation plots. J Laryngol Otol 2009;123:730-6.
Dornhoffer JL, Bailey HA Jr., Graham SS. Long-term hearing results following stapedotomy. Am J Otol 1994;15:674-8.
Kos MI, Montandon PB, Guyot JP. Short- and long-term results of stapedotomy and stapedectomy with a teflon-wire piston prosthesis. Ann Otol Rhinol Laryngol 2001;110:907-11.
Persson P, Harder H, Magnuson B. Hearing results in otosclerosis surgery after partial stapedectomy, total stapedectomy and stapedotomy. Acta Otolaryngol 1997;117:94-9.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]