title: Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis.
abstract: To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis.
  
  
  
  PubMed, EMBASE, and The Cochrane Library were searched for the terms otosclerosis, stapedotomy, and cochlear implantation and their synonyms with no language restrictions up to March 10, 2015.
  
  
  
  Studies comparing the hearing outcomes of stapedotomy with cochlear implantation and studies comparing the hearing outcomes of primary cochlear implantation with salvage cochlear implantation after an unsuccessful stapedotomy in patients with advanced otosclerosis were included. Postoperative speech recognition scores were compared using the weighted mean difference and a 95% confidence interval.
  
  
  
  Only 4 studies met our inclusion criteria. Cochlear implantation leads to significantly better speech recognition scores than stapedotomy (P < .0001). However, this appears to be due to the variability in outcomes after stapedotomy. Cochlear implantation does not lead to superior speech recognition scores compared with the subgroup of successful cases of stapedotomy plus hearing aid (P = .47). There is also no significant difference with respect to speech recognition between primary cochlear implantation and those secondary to a failed stapedotomy (P = .22).
  
  
  
  Cochlear implantation leads to a statistically greater and consistent improvement in speech recognition scores. Stapedotomy is not universally effective; however, it yields good results comparable to cochlear implantations in at least half of patients. For cases of unsuccessful stapedotomy, the option of cochlear implantation is still open, and the results obtained through salvage cochlear implantation are as good as those of primary cochlear implantation.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Quebec, Canada.|Department of Otolaryngology, First Teaching Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Abdurehim
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Quebec, Canada.|Centre for Research on Brain, Music and Language, Montreal, Quebec, Canada.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lehmann
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Quebec, Canada anthony.zeitouni@mcgill.ca.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Zeitouni
mesh_terms: D019929:Cochlear Implantation / Q000379:methods*; D006801:Humans; D010040:Otosclerosis / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D016879:Salvage Therapy; D013201:Stapes Surgery / Q000379:methods*
keywords: cochlear implantation; otosclerosis; speech recognition; stapedotomy