Outcome and lack of prognostic factors in stapes surgery.
OBJECTIVE
To analyze predictive factors of outcome after primary stapes surgery for otosclerosis.


METHODS
Retrospective review of 139 patients with otosclerosis and 147 operations performed by the same senior surgeon with the same surgical technique.


METHODS
Academic hospital and tertiary referral center.


METHODS
All patients had documented preoperative and peroperative audiologic assessments and preoperative records. The mean age of patients was 44.31 years.


METHODS
Stapedotomy with diode laser using Teflon prosthesis.


METHODS
The bone conduction threshold changes, the improvement of pure-tone average air-bone gaps (PTA-ABGs), and ABGs for each frequency were analyzed using 0.5, 1, 2, and 4 kHz. Success rate was defined by postoperative ABG. Log-rank test was used to define significant factors.


RESULTS
At 24 hours postoperative, there was a significant deterioration in bone conduction threshold at 1, 2, and 4 kHz. However, at 4 kHz, the threshold remained significantly worse at longer term. There was a significant improvement of the PTA-ABG. Eighty-six percent of patients obtained a PTA-ABG of 20 dB or less. We also obtained a significant ABG closure on every frequency except on 4 kHz. Multivariate statistical analysis had not identified a predictive factor of hearing outcomes such as the anatomy of the facial nerve, the incus, the stapes footplate and the external auditory canal, the prosthesis crimping, bleeding, and surgical damage of the tympanic membrane.


CONCLUSIONS
In experienced hands, we observed a significantly transient depression of bone conduction hearing levels that was definitively present at 4 kHz. Peroperative difficult or abnormal situations did not seem to have an influence on the hearing outcome. Those statements will enable accurate preoperative counseling. It will also permit precise matching of future series to allow accurate comparisons.
Gerard
Jean-Marc
JM
ENT Department, University Hospital Saint-Luc, Brussels, Belgium. jmarcgerard@hotmail.com
Serry
Paul
P
Gersdorff
Michel C
MC
D000328:Adult; D001309:Auditory Threshold; D001844:Bone Conduction; D004424:Ear Canal / Q000502:physiology; D005154:Facial Nerve / Q000502:physiology; D005260:Female; D006470:Hemorrhage; D006801:Humans; D007188:Incus / Q000033:anatomy & histology; D008297:Male; D019933:Ossicular Replacement; D010040:Otosclerosis / Q000503:physiopathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013201:Stapes Surgery; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery