title: A nonrandomized comparison of stapes surgery with and without a vein graft in patients with otosclerosis.
abstract: OBJECTIVE
  To evaluate the effectiveness of primary stapes surgery with and without a vein graft in patients with otosclerosis and to determine the differences in the postoperative gain in air-bone gap (ABG) and air-conduction (AC).
  
  
  METHODS
  A nonrandomized multicenter clinical evaluation.
  
  
  METHODS
  Two tertiary referral centers in The Netherlands and France.
  
  
  METHODS
  Otosclerosis patients that underwent primary stapedotomy surgery.
  
  
  METHODS
  Primary stapedotomy surgery without a vein graft (n = 939, first center) compared with primary stapedotomy surgery with a vein graft (n = 3691, second center).
  
  
  METHODS
  Preoperative and postoperative audiometric results were compared. An analysis of variance was performed to evaluate differences in postoperative ABG and AC gains between surgeries with and without a vein graft, adjusted for potential confounders.
  
  
  RESULTS
  The postoperative ABG was 10 dB or lesser in 72.1% of the patients without a vein graft and in 93.2% of patients with a vein graft. After adjustments for differences at baseline, the mean gain in ABG was 18.6 dB (95% CI, 18.1-19.1) in the group without vein graft, compared with 24.2 dB (95% CI, 23.9-24.6) in the group with vein graft (mean difference, 5.6 dB; 95% CI, 5.0-6.2). The mean gain in AC was 19.5 dB (95% CI, 18.7-20.3) in the group without vein graft, compared with 24.3 dB (95% CI, 23.7-24.7) in the group with vein graft (mean difference, 4.8 dB; 95% CI, 3.8-5.7).
  
  
  CONCLUSIONS
  Patients with otosclerosis undergoing primary stapes surgery may benefit more from a vein graft interposition.
  
  
  METHODS
  2B.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Arnold J N
authors.initials: AJ
authors.lastname: Bittermann
authors.forename: Robert
authors.initials: R
authors.lastname: Vincent
authors.forename: Maroeska M
authors.initials: MM
authors.lastname: Rovers
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: Rinze A
authors.initials: RA
authors.lastname: Tange
authors.forename: Wouter A
authors.initials: WA
authors.lastname: Dreschler
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006309:Hearing / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000601:surgery*; D013201:Stapes Surgery / Q000379:methods; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery / Q000637:transplantation*; D055815:Young Adult