title: Decisive criteria between stapedotomy and cochlear implantation in patients with far advanced otosclerosis.
abstract: OBJECTIVE
  To describe the hearing outcomes in patients with far-advanced otosclerosis and to identify the best initial approach based on preoperative word recognition scores (WRS), pure tone averages (PTA), and radiological classification.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Academic neurotology tertiary referral center.
  
  
  METHODS
  All patients (n = 58) with preoperative air conduction PTA less than 85 dB (HL), disyllabic WRS less than or equal to 50% at 60 dB (HL) with well-fitted hearing aids, and evidence of otosclerosis on CT scan, treated in our department over the past 20 years.
  
  
  METHODS
  Stapedotomy, cochlear implantation, or both.
  
  
  METHODS
  Postoperative WRS after a minimum of 12 months' follow-up, percentage of patients with WRS greater than 50%. Reliability of air and bone conduction PTAs and WRS in predicting failure of stapedotomy.
  
  
  RESULTS
  Fifty-eight patients were divided into three groups: group I, primary stapedotomy (n = 32); group II, primary cochlear implantation (n = 9); and group III, secondary cochlear implantation (with a previous history of stapedotomy) (n = 25). The mean postoperative WRS were 50.6% (± 34), 75% (± 17), and 72% (± 20), respectively. Sixty percent of patients in the stapedotomy group had a postoperative WRS greater than 50% requiring no further treatment, compared to 85% for cochlear implant recipients. No specific predictive factors for stapedotomy outcome could be identified. Surgical difficulties during cochlear implantation were significantly higher in patients with advanced radiological stage.
  
  
  CONCLUSIONS
  Although cochlear implantation gives better overall results, stapedotomy with hearing aids can still be very effective in the management of patients with far-advanced otosclerosis. It should therefore be proposed as a first-line treatment.
authors.affiliation: *Department of Otology-Neurotology and Skull Base Surgery, Purpan University Hospital, Toulouse, France; †Department of Statistics, Paul Sabatier University, Toulouse, France; ‡Department of Neuroradiology, Clinique Pasteur, Toulouse, France; and §Centre National de la Recherche Scientifique (CNRS), CerCo, Toulouse, France.
authors.forename: Bilal
authors.initials: B
authors.lastname: Kabbara
authors.forename: Clement
authors.initials: C
authors.lastname: Gauche
authors.forename: Marie-Noelle
authors.initials: MN
authors.lastname: Calmels
authors.forename: Benoit
authors.initials: B
authors.lastname: Lepage
authors.forename: Bernard
authors.initials: B
authors.lastname: Escude
authors.forename: Olivier
authors.initials: O
authors.lastname: Deguine
authors.forename: Bernard
authors.initials: B
authors.lastname: Fraysse
authors.forename: Mathieu
authors.initials: M
authors.lastname: Marx
mesh_terms: D000368:Aged; D001844:Bone Conduction; D003051:Cochlea / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D003657:Decision Making; D005260:Female; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D013067:Speech Perception / Q000502:physiology; D013201:Stapes Surgery / Q000379:methods*; D016896:Treatment Outcome