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Luca M, Massimilla EA, Americo M, Michele N, Donadio A, Gaetano M. Stapes Surgery in Far-Advanced Otosclerosis. EAR, NOSE & THROAT JOURNAL 2023; 102:611-615. [PMID: 33971751 DOI: 10.1177/01455613211013093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Surgical treatment of patients with far-advanced otosclerosis (FAO) has not yet been standardized. Patients with FAO are the candidates for stapes surgery or cochlear implant (CI). Although many surgeons consider stapes surgery as the first choice, other authors prefer CI because of the excellent hearing results. OBJECTIVE The authors discuss their experience in the treatment of patients with FAO, potentially candidates for CI, who underwent stapedotomy. MATERIALS AND METHODS Eleven adult patients with FAO underwent stapedotomy from 2006 to 2016. Pure-tone average (PTA) between 0.5-1-2-3 kHz and speech perception test with hearing aids were determined before and after stapedotomy. RESULTS The results show a statistically significant improvement in air condition threshold (PTA) and satisfactory results with regard to speech recognition in 9 (81.8%) cases. Postoperative results are not influenced by the type of stapedotomy prosthesis employed and do not change during follow-up (3 years). CONCLUSIONS The authors suggest first performing stapes surgery in patients with FAO and reserving CI in case of failure.
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Affiliation(s)
- Moscillo Luca
- ENT Department, L. Vanvitelli University, Naples, Italy
- ENT Department, "S. Maria delle Grazie" Hospital, Pozzuoli, Naples), Italy
| | | | - Mastella Americo
- ENT Department, "S. Maria delle Grazie" Hospital, Pozzuoli, Naples), Italy
| | | | - Anna Donadio
- ENT Department, L. Vanvitelli University, Naples, Italy
| | - Motta Gaetano
- ENT Department, L. Vanvitelli University, Naples, Italy
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Teaima AA, Elnashar AA, Hakim EK, Hadaey HS. Comparison of the efficacy of cochlear implantation and stapes surgery in far advanced otosclerosis: a meta-analysis study. Eur Arch Otorhinolaryngol 2023; 280:77-88. [PMID: 35687184 PMCID: PMC9813143 DOI: 10.1007/s00405-022-07449-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/11/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study is to compare the hearing outcomes and complications of stapes surgery and cochlear implantation (CI) in patients with far-advanced otosclerosis (FAO). DATA SOURCES A comprehensive electronic search of PubMed/MEDLINE, Scopus, Web of science and Cochrane Library was conducted in June 2021 for articles in the literature till this year. STUDY SELECTION Studies are published in English language, conducted on human subjects, concerned with comparison of CI and stapes surgery in the management of FAO, not Laboratory study and not Opinion study. The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). DATA EXTRACTION Twenty-six studies were included with 334 patients in CI group and 241 patients in stapes surgery group. Comparison between both groups was done in terms of postoperative complications, audiological outcomes, rete of revision surgery and patients' satisfaction rate. RESULTS Postoperative complications rate was significantly lower in CI (13.6%) than stapes surgery (18.6%). CI had a significantly lower rate of revision surgery (8.1%) than stapes surgery (16.4%). CI had a better mean for pure tone average (29.1 dB) than stapedectomy (52.3 dB) while stapes surgery had a higher mean for recognition of monosyllables and disyllables than CI. CI had significantly higher satisfaction rate than stapes surgery. CONCLUSION Both Stapes surgery and CI are reliable treatment options for FAO with close success rates. Statistics of CI are greater than stapes surgery and CI has a consistent improvement in audiometric outcomes in comparison to stapes surgery.
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Affiliation(s)
- Ahmed Abdelmoneim Teaima
- Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Abbassia Square, Ramses Street, Cairo, 11591, Egypt.
| | - Abdelhamid Abdelhamid Elnashar
- Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Abbassia Square, Ramses Street, Cairo, 11591 Egypt
| | - Ehab Kamal Hakim
- Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Abbassia Square, Ramses Street, Cairo, 11591 Egypt
| | - Hanaa Sabry Hadaey
- Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Abbassia Square, Ramses Street, Cairo, 11591 Egypt
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Cochlear Implantation in Advanced Otosclerosis: Pitfalls and Successes. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
This review will highlight recent outcome-based evidence guiding decision making for cochlear implantation in advanced otosclerosis, related complications, and technical surgical considerations in otosclerosis and the obstructed cochlea.
Recent Findings
Cochlear implantation in advanced otosclerosis results in consistent, excellent auditory outcomes with improvement in both objective speech recognition scores and subjective quality of life measures. Facial nerve stimulation may occur at higher rates in otosclerosis cochlear implant recipients. Cochlear implantation in the setting of luminal obstruction in osteosclerotic patients may be managed with altered surgical technique to achieve successful auditory improvements. Pre-operative imaging with high resolution CT or MRI may help anticipate intraoperative challenges and post-operative complications in cochlear implantation.
Summary
Cochlear implantation is an established, successful treatment for profound hearing loss in advanced otosclerosis. Surgeon knowledge of outcomes, complications, and potential surgical challenges is important to appropriately counsel patients regarding auditory rehabilitation options in advanced otosclerosis.
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Wardenga N, Diedrich V, Waldmann B, Lenarz T, Maier H. Hearing Aid Treatment in Patients with Mixed Hearing Loss. Part I: Expected Benefit and Limitations after Stapes Surgery. Audiol Neurootol 2020; 25:125-132. [PMID: 32045919 DOI: 10.1159/000502994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/10/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to determine the fraction of patients with mixed hearing loss who can or cannot expect benefit from power hearing aids (HAs) after stapes surgery. DESIGN The audiological outcome of 374 stapes surgeries was used to calculate the patients' individual postoperative requirements in terms of gain and output of HAs. These requirements were compared to the available gain and output provided by state-of-the-art power HAs at 0.5, 1.0, 2.0, and 4.0 kHz. According to these comparisons, ears were divided into three groups. For G0, required gain and output lay within the corresponding technical limits of the HAs at all frequencies. In G1, one or both requirements could not be fulfilled at 1 frequency. G2 combined all ears where the requirements lay beyond the HA's technical limitations at 2 or more frequencies. RESULTS Stapes surgery resulted in an improvement of air-bone gap (ABG) in 84.5% of the cases by 15.7 dB on average. Based on pure-tone average (0.5, 1.0, 2.0, 4.0 kHz), 40.6% of all cases showed an ABG ≤10 dB. 44.9% of all cases did no longer need a HA after stapes surgery. A power HA would fulfill both audiological criteria at all 4 frequencies in 81.6% of cases that needed a HA postoperatively. However, 18.4% would not be sufficiently treatable at 1 or more frequencies (15.0% in G1, 3.4% in G2). CONCLUSIONS The present study identified a subset of patients with mixed hearing loss after stapes surgery that cannot be treated sufficiently with available power HAs. As the residual ABG is an important reason for this lack of treatment success, the advancement of alternative hearing devices that circumvent the middle ear, such as powerful active middle ear implants, is indicated.
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Affiliation(s)
- Nina Wardenga
- Cluster of Excellence Hearing4all, Hannover, Germany, .,Department of Otolaryngology, Hannover Medical School, Hannover, Germany,
| | - Victoria Diedrich
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | | | - Thomas Lenarz
- Cluster of Excellence Hearing4all, Hannover, Germany.,Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Hannes Maier
- Cluster of Excellence Hearing4all, Hannover, Germany.,Department of Otolaryngology, Hannover Medical School, Hannover, Germany
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Marchioni D, Soloperto D, Bianconi L, Guarnaccia MC, Genovese E, Presutti L. Endoscopic approach for cochlear implantation in advanced otosclerosis: A case report. Auris Nasus Larynx 2016; 43:584-90. [PMID: 27106776 DOI: 10.1016/j.anl.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 03/05/2016] [Accepted: 03/13/2016] [Indexed: 12/20/2022]
Abstract
HYPOTHESIS Ossification of the cochlea was once considered to be a contraindication for cochlear implantation. Advances in cochlear implant technology and coding strategies have led to developments in different surgical procedures to manage cochlear ossification. The endoscopic technique allows a direct approach to the round window and the cochlea, especially in remodeled labyrinth, allowing a better vision of scala tympani. BACKGROUND Tertiary referral ENT center. METHODS Between January 2011 and February 2015 three patients with far advanced otosclerosis with partial obliteration of the cochlea were selected and underwent endoscopic-assisted cochlear implantation. RESULTS In far advanced otosclerosis, endoscopy allowed a magnification of the anatomy of the round window, permitting the surrounding anatomical structures forming the anatomy of the niche to be identified, and avoiding a blind dissection. No postoperative complications were noted, in particular, no surgical site infection, no vertigo, and no facial nerve injuries. Implant activation was routinely performed 1 month after surgery. All monitoring till date has indicated that the external auditory ducts are well ventilated and there are no signs of extrusion. CONCLUSIONS Ossification may occur as a consequence of the pathology of meningitis, chronic otitis media, severe otosclerosis, autoimmune inner ear diseases, temporal bone traumas, and other diseases. Advances in cochlear implant technology and coding strategies have led to developments in different surgical procedures to manage cochlear ossification. Supported by a number of years of experience in the field of otoendoscopic surgery, we propose a technique for cochlear implantation under unfavorable conditions using endoscopic-assisted surgery, especially in advanced otosclerosis. This technique permits us to extend the indication for cochlear implantation, and in our opinion will reduce the morbidity associated with this surgical procedure.
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Affiliation(s)
- Daniele Marchioni
- Otolaryngology Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Davide Soloperto
- Otolaryngology Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Luca Bianconi
- Otolaryngology Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy.
| | - Maria C Guarnaccia
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Elisabetta Genovese
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Livio Presutti
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
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Castillo F, Polo R, Gutiérrez A, Reyes P, Royuela A, Alonso A. Cochlear implantation outcomes in advanced otosclerosis. Am J Otolaryngol 2014; 35:558-64. [PMID: 24989154 DOI: 10.1016/j.amjoto.2014.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Several studies support the use of cochlear implants (CI) in far-advanced otosclerosis (FAO). MATERIAL AND METHODS We compared our results of CI in patients with FAO and unknown origin hearing loss (UOHL) and our incidence of facial electrical stimulation and difficult insertion of the electrode bundle up to 3 to 5 years from surgery. RESULTS We found 17 patients with CI in FAO and UOHL. FAO patients achieved better results on the pure tone average (PTA) and recognition of monosyllables by GEE test (p=0.022; p=0.006), and particularly at 1 year on the PTA (p=0.002), at 6 months and a year in monosyllables (p=0.002; p=0.001), and at 6 months in disyllables (p=0.004). There were no differences toward complications. CONCLUSION In our experience, placement of CI in FAO has proven successful, with results comparable to other similar cohorts, and with low complications.
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Merkus P, van Loon MC, Smit CF, Smits C, de Cock AFC, Hensen EF. Decision making in advanced otosclerosis: An Evidence-Based Strategy. Laryngoscope 2011; 121:1935-41. [DOI: 10.1002/lary.21904] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 04/29/2011] [Accepted: 05/09/2011] [Indexed: 11/05/2022]
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Calmels MN, Viana C, Wanna G, Marx M, James C, Deguine O, Fraysse B. Very far-advanced otosclerosis: stapedotomy or cochlear implantation. Acta Otolaryngol 2007; 127:574-8. [PMID: 17503225 DOI: 10.1080/00016480600987768] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONCLUSION Every patient with severe or profound hearing loss must have a temporal bone high-resolution computed tomography (CT) scan. Stapedotomy is a simple, safe and low-cost procedure compared with cochlear implantation and can provide very good results. This can justify our decision to propose stapedotomy at the initial treatment in patients with very far-advanced otosclerosis. In cases of hearing failure after stapes surgery, cochlear implantation is an option. OBJECTIVE This study aimed to find the best first intention treatment of very far-advanced otosclerosis. MATERIALS AND METHODS This was a retrospective study and included 14 patients with non-measurable preoperative bone and air conduction thresholds and otosclerosis on temporal bone high-resolution CT scan. Stapes surgery followed by a well fitted hearing aid was the initial treatment in 11 patients and cochlear implantation in 7 patients, including 4 patients who had poor results after stapedotomy. Objective and subjective audiometric results were studied and compared between stapedotomy and cochlear implantation groups. RESULTS Objective and subjective results were statistically better in the cochlear implant group than in the stapedotomy group. However, four patients in the stapedotomy group had comparable results to the patients with cochlear implants.
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Affiliation(s)
- Marie-Noëlle Calmels
- Department of Otology-Neurotology and Skull Base Surgery, Purpan Hospital, Toulouse, CHU Toulouse, France.
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Rama-López J, Cervera-Paz FJ, Manrique M. Cochlear Implantation of Patients with Far-Advanced Otosclerosis. Otol Neurotol 2006; 27:153-8. [PMID: 16436983 DOI: 10.1097/01.mao.0000197387.29534.26] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This current single-subject, repeated-measures study was to describe our experience with 30 patients who had been diagnosed with "far-advanced otosclerosis" and who were included in our program of cochlear implants. We analyzed the history of the patients and their families before implantation, the surgical findings, and the performance over a follow up of 3 years. MATERIAL AND METHODS All patients met one or more of the after criteria: 1) previous surgical intervention as a treatment of their otosclerosis; 2) signs of pericochlear hypodensities in high resolution computed tomography (HRCT) scans; and 3) family precedents of otosclerosis. All underwent standard surgical cochlear implantation. RESULTS In 78% of the cases, a stapedectomy had previously been realized. Cochlear otosclerosis could be appreciated in HRCT in 78% of the patients. A family history of otosclerosis was found in 40%, and 33.3% of patients had familial precedents of nonfilial hypoacusis. The mean results in the two-syllable test were 20% preimplantation, 54% 6 months after implantation, and 52%, 62%, 54% at 1, 2, and 3 years after implantation. In the CID sentence test, they were in the order of 32% preimplantation and of 64% at 6 months, 66% after 1 year, of 68% after 2 years, and reaching 72% after 3 years. No complications related to the surgery were detected. CONCLUSION Patients diagnosed with far-advanced otosclerosis have a good prognosis with cochlear implantation comparable to that of other patients in whom postlingual implants are performed.
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Affiliation(s)
- Julio Rama-López
- Department of Otolaryngology, University Hospital and Medical School, University of Navarra, Navarra, Spain
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Marshall AH, Fanning N, Symons S, Shipp D, Chen JM, Nedzelski JM. Cochlear Implantation in Cochlear Otosclerosis. Laryngoscope 2005; 115:1728-33. [PMID: 16222185 DOI: 10.1097/01.mlg.0000171052.34196.ef] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to correlate implant performance in cochlear otosclerosis to 1) matched control samples, 2) severity of otic capsule involvement, 3) prior ipsilateral surgery, and 4) programming issues. STUDY DESIGN Retrospective case controlled study. METHODS Study cohort comprised 30 individuals. Diagnosis was based on prior ear surgery (stapedectomy [n = 18] or fenestration [n = 2]) and/or pathognomonic radiological findings. High-resolution computed tomography images of the temporal bones were assessed by two radiologists and graded (range, 0-3) for the extent of otosclerosis. Operative records were reviewed. Performance, programming visits, and the number of electrode deactivations at 6 months and at 1 year after implantation were determined for the individuals with otosclerosis and compared with a group of matched control subjects. A within-group comparison correlating severity of otosclerosis to the above was carried out. RESULTS Implant performance in individuals with cochlear otosclerosis was not significantly different from those without. Previous surgery on the side of implantation did not alter performance. Programming difficulty as reflected in the number of visits and electrode deactivation for sound quality reasons were comparable. Deactivation for facial nerve stimulation occurred exclusively in otosclerotics with the most severe radiological disease (grade 3) and was only with non-modiolar hugging electrodes (n = 5). There was no observed difference between the radiological extent of otosclerosis and implant performance. CONCLUSION Individuals with severe otosclerosis considering cochlear implantation can be counseled to expect similar benefit to those without, regardless of whether prior surgery occurred on the side of implantation or of severity of otic capsule involvement. There is a significant risk of facial nerve stimulation in otosclerotics with grade 3 disease.
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Affiliation(s)
- A H Marshall
- Department of Otolaryngology--Head and Neck Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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Quaranta N, Bartoli R, Lopriore A, Priore AL, Fernandez-Vega S, Giagnotti F, Quaranta A. Cochlear Implantation in Otosclerosis. Otol Neurotol 2005; 26:983-7. [PMID: 16151347 DOI: 10.1097/01.mao.0000185047.77017.31] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate and compare the results obtained in a group of implanted otosclerotic patients with a group of cochlear implant (CI) patients not affected by otosclerosis. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Nine patients affected by profound sensorineural hearing loss caused by otosclerosis and nine patients affected by profound sensorineural hearing loss not caused by otosclerosis were evaluated. INTERVENTION Cochlear implantation. MAIN OUTCOME MEASURES Preoperative imaging, intraoperative findings, postoperative facial nerve stimulation, and speech perception performance measures were performed and the data analyzed. RESULTS Otosclerosis patients showed signs of cochlear ossification both on high-resolution computed tomography scans and intraoperatively. The incidence of facial nerve stimulation was higher in the otosclerosis group, three out of nine, and was generally related to the use of electrical stimulation from the Nucleus 22 cochlear implant. Psychophysical and speech perception measures did not show significant differences between the two groups, despite some otosclerosis patients showing increased electrical thresholds and comfort levels and slightly poorer speech perception performance scores. CONCLUSIONS Patients with otosclerosis who have progressed to profound hearing loss derive significant benefit from cochlear implants; however, an increased risk of cochlear ossification and facial nerve stimulation has to be taken in account during preoperative counseling. The advance in imaging techniques, CI technology and the possibility to stimulate precise regions of the cochlea with lower intensities make it possible for the surgeons and audiologists to readily and successfully manage these complications as they arise.
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Affiliation(s)
- Nicola Quaranta
- The Otorhinolaryngology Clinic G. Lugli, Otologic and Neurotologic Surgery, Department of Ophtalmology and Otorhinolaryngology, University of Bari, Bari, Italy
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Ruckenstein MJ, Rafter KO, Montes M, Bigelow DC. Management of far advanced otosclerosis in the era of cochlear implantation. Otol Neurotol 2001; 22:471-4. [PMID: 11449102 DOI: 10.1097/00129492-200107000-00010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate issues pertaining to cochlear implantation in patients with far advanced cochlear otosclerosis. STUDY DESIGN Prospective cohort. SETTING Tertiary care referral center. PATIENTS Eight adult patients (18 years of age or older) referred for management of profound hearing loss, the cause of which was determined to be otosclerosis. INTERVENTION Cochlear implantation with multichannel cochlear implant device. MAIN OUTCOME MEASURES Benefit from cochlear implant as measured by CID sentence scores, incidence and management of facial nerve stimulation, and technical issues pertaining to cochlear implantation in this patient population. RESULTS All patients demonstrated significant improvement in auditory function as measured by performance on CID sentence scores and ability to engage in telephone conversation. Facial nerve stimulation was present in two of eight patients and was managed with deactivation of the stimulating electrodes. Ossification in the basal turn of the cochlea, detected on preoperative computed tomography, necessitated placement of the electrode into the scala vestibuli in two patients and use of a thinner electrode (Nucleus 24) in a third patient. CONCLUSION Patients with profound hearing loss secondary to otosclerosis derive excellent benefits from cochlear implantation. Surgical implantation may be complicated by ossification of the cochlea, which can be detected on preoperative computed tomography. Electrode activation may be complicated by facial nerve stimulation, which can be addressed with programming strategies.
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Affiliation(s)
- M J Ruckenstein
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Abstract
OBJECTIVE The purpose of this study is to investigate the clinical aspects of profound hearing loss (PHL) and their significance for defining deafness. METHODS The audiological data were reviewed from 3660 patients who were evaluated in the Otolaryngology Clinic at Louisiana State University in Shreveport, LA, over a 5-year period. The medical charts from the patients were also reviewed for the information of medical diagnosis, surgical records and radiological findings. RESULTS There were 34 patients identified with bilateral PHL or deaf, 177 patients with unilateral PHL and 123 patients with borderline PHL. Congenital hearing loss and unknown-cause hearing loss in this series were predominant with 267 cases (79.9%). A surgical management was indicated in 39 cases (11.7%) including middle ear infection, ossicular chain abnormalities and auditory nerve/brainstem tumors. CONCLUSION This study suggests that audiometrically PHL should be thoroughly evaluated to detect reversible or remediable conditions by surgical and medical approaches. The diagnosis of deafness should be confirmed by an integration of the audiological data and medical documents including surgical and radiological findings. Aural rehabilitation program should be designed for deaf patients with varied etiology and degree of residual peripheral hearing sensitivity following medical clearance.
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Affiliation(s)
- W W Qiu
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University, Medical Center in Shreveport 71130-3359, USA
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Abstract
Patients with far-advanced otosclerosis (FAO) may appear to be suffering from profound sensorineural hearing loss and are frequently directed to cochlear implantation programmes. In order to avoid such misdiagnosis, FAO should be considered in patients with non-measurable bone-conduction levels and air-conduction levels exceeding 85 dB. Specific clues can lead the clinician to suspect otosclerosis as the aetiology of hearing loss. A review of eight patients (nine ears) with FAO who underwent stapedectomy from 1985-1995 reveals that six of the eight (75 per cent) who had been unable to use a hearing aid preoperatively obtained serviceable hearing with a hearing aid after surgery. This confirms that cochlear implantation is not the best treatment for all profoundly deaf patients; some are better off with stapedectomy.
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Affiliation(s)
- A Khalifa
- Department of Otolaryngology-Head and Neck Surgery, Tanta Faculty of Medicine, Egypt
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