Hearing gain in patients undergoing stapes surgery for otosclerosis
Abstract Introduction and objective: Otosclerosis is a cause of hearing loss in young people, more frequently in women. Stapes surgery is a widely accepted corrective procedure, with the advent of technology and changes in technique, the question arises as to whether there are differences between them. Objective: To evaluate whether there are differences in hearing gain between techniques and approaches of stapes surgeries in patients with otosclerosis. Method: Demographic, clinical and surgical variables were collected. Descriptive statistics were applied. The Mann-Whitney U test was used for numerical variables, as well as the Kruskal Wallis test to compare differences in three or more groups. A p value ≤ 0.05 was considered significant. Results: Between 2020 and 2023, 55 stapes surgeries were performed for otosclerosis, of which 20 had to be excluded. Of 35 surgeries in 31 patients, mean age 41.16 ± 8.64 years, 77.4% were women, 51.4% were in the right ear; Comorbidities were present in 25.7%, 5 complications presented hearing loss, in 88.6% of the procedures a satisfactory closure of the air-bone gap was found. There was no difference between stapes surgery techniques and postsurgical audiological results p=0.872, nor with the type of visualization approach p=0.636. Discussion: Our results are similar to what some authors found, however, there is still uncertainty about the best technique. Conclusions: No statistically significant differences were found in terms of hearing gain with the visualization approach and the type of procedure in the stapes for placement of the prosthesis.
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Arnold W. Some remarks on the histopathology of otosclerosis. Adv Otorhinolaryngol. 2007;65:25-30. DOI: https://doi.org/10.1159/000098665.
Grayeli AB, Escoubet B, Bichara M, Julien N, Silve C, Friedlander G, Sterkers O, Ferrary E. Increased activity of the diastrophic dysplasia sulfate transporter in otosclerosis and its inhibition by sodium fluoride. Otol Neurotol. 2003 Nov;24(6):854-62. DOI: https://doi.org/10.1097/00129492-200311000-00005.
Chole RA. Osteoclasts in chronic otitis media, cholesteatoma, and otosclerosis. Ann Otol Rhinol Laryngol. 1988 Nov-Dec;97(6 Pt 1):661-6. DOI: https://doi.org/10.1177/000348948809700615.
Ruckenstein MJ, Staab JP. Who is performing stapedectomy surgery? Implications for residency and fellowship training. Laryngoscope. 2008 Jul;118(7):1224-7. DOI: https://doi.org/10.1097/MLG.0b013e31816e2ede
Macielak RJ, Marinelli JP, Totten DJ, Lohse CM, Grossardt BR, Carlson ML. Pregnancy, Estrogen Exposure, and the Development of Otosclerosis: A Case-Control Study of 1196 Women. Otolaryngol Head Neck Surg. 2021 Jun;164(6):1294-1298. DOI: https://doi.org/10.1177/0194599820966295.
Liao S, Lu S, Li G, Chen R. Increased maternal serum placental growth hormone variant in pregnancies complicated by otosclerosis. Clin Otolaryngol. 2019 Sep;44(5):757-761. DOI: https://doi.org/10.1111/coa.13385.
Declau F, Spaendonck MV, Timmermans JP, Michaels L, Liang J, Qiu JP, Van de Heyning P. Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians. Adv Otorhinolaryngol. 2007;65:6-16. DOI: https://doi.org/10.1159/000098663.
Rudic M, Keogh I, Wagner R, Wilkinson E, Kiros N, Ferrary E, Sterkers O, Bozorg Grayeli A, Zarkovic K, Zarkovic N. The pathophysiology of otosclerosis: Review of current research. Hear Res. 2015 Dec;330(Pt A):51-6. DOI: https://doi.org/10.1016/j.heares.2015.07.014.
Chole RA, McKenna M. Pathophysiology of otosclerosis. Otol Neurotol. 2001 Mar;22(2):249-57. DOI: https://doi.org/10.1097/00129492-200103000-00023. PMID: 11300278.
Zukić B, Anđelković M, Gašić V, Grubin J, Pavlović S, Đerić D. Genetic basis of otosclerosis. Srpski Arhiv za Celokupno Lekarstvo. 2020;148: 621–625.
Quesnel AM, Ishai R, McKenna MJ. Otosclerosis: Temporal Bone Pathology. Otolaryngol Clin North Am. 2018 Apr;51(2):291-303. DOI: https://doi.org/10.1016/j.otc.2017.11.001. Epub 2018 Feb 3.
Persson P, Harder H, Magnuson B. Hearing results in otosclerosis surgery after partial stapedectomy, total stapedectomy and stapedotomy. Acta Otolaryngol. 1997 Jan;117(1):94-9. DOI: https://doi.org/10.3109/00016489709117998.
Ahmad M, Chari DA, McKenna MJ, Quesnel AM. Mixed and Sensorineural Hearing Loss in Otosclerosis: Incidence, Pathophysiology, and Treatment. Current Otorhinolaryngology Reports. 2022;10:8-15.
Salem M, Wishahi H, Abd El-Raziq M, Asham M. Endoscopic Versus Microscopic Stapedectomy For Treatment of Otosclerosis. Egypt J Neck Surg Otorhinolaryngol. 2019;5(2):28-39. DOI: https://doi.org/10.21608/ejnso.2019.57906.
Kojima H, Komori M, Chikazawa S, Yaguchi Y, Yamamoto K, Chujo K, Moriyama H. Comparison between endoscopic and microscopic stapes surgery. Laryngoscope. 2014 Jan;124(1):266-71. DOI: https://doi.org/10.1002/lary.24144. Epub 2013 May 13.
Iannella G, Magliulo G. Endoscopic Versus Microscopic Approach in Stapes Surgery: Are Operative Times and Learning Curve Important for Making the Choice? Otol Neurotol. 2016 Oct;37(9):1350-7. DOI: https://doi.org/10.1097/MAO.0000000000001186.
Cheng HCS, Agrawal SK, Parnes LS. Stapedectomy Versus Stapedotomy. Otolaryngol Clin North Am. 2018 Apr;51(2):375-392. DOI: https://doi.org/10.1016/j.otc.2017.11.008.
Thamjarayakul T., Supiyaphun P., Snidvongs K..Cirugía de fijación del estribo: estapedectomía versus estapedotomía. Biomedicina asiática. 2010;4(3): 429-434. https://doi.org/10.2478/abm-2010-0052
House HP, Hansen MR, Al Dakhail AA, House JW. Stapedectomy versus stapedotomy: comparison of results with long-term follow-up. Laryngoscope. 2002;112(11):2046-50. DOI: https://doi.org/10.1097/00005537-200211000-00025.
Dundar R, Iynen I, Buyruk A. Different approach for surgery of stapes: Comparison microscopic and endoscopic approach. Am J Otolaryngol. 2022 Jan-Feb;43(1):103242. DOI: https://doi.org/10.1016/j.amjoto.2021.103242IF: 2.5 Q2. Epub 2021 Sep 16. PMID: 34543947IF: 2.5 Q2 .
Harikumar B, Arun Kumar KJ. Comparative study between microscopic and endoscopic stapes surgery. Int J Otorhinolaryngol Head Neck Surg. 2017;3(2):285. https://doi.org/10.18203/issn.2454-5929.ijohns20171179
Plodpai Y. The utility and safety of diode laser in endoscopic stapes surgery. Laryngoscope Investig Otolaryngol. 2023 Mar 23;8(2):561-567. DOI: https://doi.org/10.1002/lio2.1045IF: 1.9 Q3 . PMID: 37090885IF: 1.9 Q3; PMCID: PMC10116957IF: 1.9 Q3 .
Moneir W, Eladl HM, El-Okda MM, Ebada HA. Chorda tympani injury during endoscopic versus microscopic stapes surgery: a randomized controlled clinical trial. Eur Arch Otorhinolaryngol. 2023 Feb;280(2):689-693. DOI: https://doi.org/10.1007/s00405-022-07550-0.
Armenta-villanueva RM, Santos-mejía FPBL. Experiencia en el tratamiento quirúrgico de la otoesclerosis. Rev Espec Med Quir. 2019;24:30–9.
Kageyama-Escobar AM, Tornero-Villegas KI, Vivar-Acevedo E, Ceballos-Lizarraga R, Torres-Valenzuela A, Vargas-Aguayo AM. Evaluación audiológica de la técnica de estapedectomía con prótesis de Schuknecht en pacientes con otoesclerosis. Cir Cir. 2001;69(6):286-290.
Rodríguez-Quintana OS, Lugo-Machado JA, Méndez-Cázares JA, Zavala-Contreras N, Vargas-Cárdenas LG, Rubio-Espinoza AA. et al. Resultados audiológicos en cirugía de estribo por otosclerosis en un centro de tercer nivel del noroeste de México. Re med Clin.. 2020;4(2):73–78.
Lira R Karina, Rosenbaum F Andrés, García-Huidobro N Francisco, Astudillo S Jorge, Huidobro D Bárbara, Caro L Jorge et al . Resultados auditivos del tratamiento quirúrgico de la otoesclerosis en el Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile. Rev. Otorrinolaringol. Cir. Cabeza Cuello. 2019;79( 4 ): 421-427. DOI: https://doi.org/ http://dx.doi.org/10.4067/S0718-48162019000400421.28.
Socha Gonzalez M, Macías-Tolosa C, Martínez H. Experiencia en estapedotomía en el Hospital Universitario Clínica San Rafael entre 2018 y 2019. Acta Otorrinolaringol Cir Cabeza Cuello 2020;48(3):213–7. https://doi.org/10.37076/acorl.v48i3.490
Fan CJ, Kaul VF, Mavrommatis MA, Schwam ZG, Hu S, Kong DK, Phan NM, Villavisanis DF, Cosetti MK, Wanna GB. Endoscopic Versus Microscopic Stapedotomy: A Single-Blinded Randomized Control Trial. Otol Neurotol. 2021 Dec 1;42(10):1460-1466. DOI: https://doi.org/10.1097/MAO.0000000000003298
Das A, Mitra S, Ghosh D, Sengupta A. Endoscopic Stapedotomy: Overcoming Limitations of Operating Microscope. Ear Nose Throat J. 2021 Feb;100(2):103-109. DOI: https://doi.org/10.1177/0145561319862216.
Koukkoullis A, Tóth I, Gede N, Szakács Z, Hegyi P, Varga G, Pap I, Harmat K, Németh A, Szanyi I, Lujber L, Gerlinger I, Révész P. Endoscopic versus microscopic stapes surgery outcomes: A meta-analysis and systematic review. Laryngoscope. 2020 Aug;130(8):2019-2027. DOI: https://doi.org/10.1002/lary.28353. Epub 2019 Nov 12.
Ho S, Patel P, Ballard D, Rosenfeld R, Chandrasekhar S. Systematic Review and Meta-analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation. Otolaryngol Head Neck Surg. 2021 Nov;165(5):626-635. DOI: https://doi.org/10.1177/0194599821990669. Epub 2021 Feb 2.
Fang L, Xu J, Wang W, Huang Y. Would endoscopic surgery be the gold standard for stapes surgery in the future? A systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2021 Apr;278(4):925-932. DOI: https://doi.org/10.1007/s00405-020-06132-2.
Surmelioglu O, Ozdemir S, Tarkan O, Tuncer U, Dagkiran M, Cetik F. Endoscopic versus microscopic stapes surgery. Auris Nasus Larynx. 2017 Jun;44(3):253-257. DOI: https://doi.org/10.1016/j.anl.2016.07.001
Manna S, Kaul VF, Gray ML, Wanna GB. Endoscopic Versus Microscopic Middle Ear Surgery: A Meta-analysis of Outcomes Following Tympanoplasty and Stapes Surgery. Otol Neurotol. 2019 Sep;40(8):983-993. DOI: https://doi.org/10.1097/MAO.0000000000002353.
Grayeli AB, Escoubet B, Bichara M, Julien N, Silve C, Friedlander G, Sterkers O, Ferrary E. Increased activity of the diastrophic dysplasia sulfate transporter in otosclerosis and its inhibition by sodium fluoride. Otol Neurotol. 2003 Nov;24(6):854-62. DOI: https://doi.org/10.1097/00129492-200311000-00005.
Chole RA. Osteoclasts in chronic otitis media, cholesteatoma, and otosclerosis. Ann Otol Rhinol Laryngol. 1988 Nov-Dec;97(6 Pt 1):661-6. DOI: https://doi.org/10.1177/000348948809700615.
Ruckenstein MJ, Staab JP. Who is performing stapedectomy surgery? Implications for residency and fellowship training. Laryngoscope. 2008 Jul;118(7):1224-7. DOI: https://doi.org/10.1097/MLG.0b013e31816e2ede
Macielak RJ, Marinelli JP, Totten DJ, Lohse CM, Grossardt BR, Carlson ML. Pregnancy, Estrogen Exposure, and the Development of Otosclerosis: A Case-Control Study of 1196 Women. Otolaryngol Head Neck Surg. 2021 Jun;164(6):1294-1298. DOI: https://doi.org/10.1177/0194599820966295.
Liao S, Lu S, Li G, Chen R. Increased maternal serum placental growth hormone variant in pregnancies complicated by otosclerosis. Clin Otolaryngol. 2019 Sep;44(5):757-761. DOI: https://doi.org/10.1111/coa.13385.
Declau F, Spaendonck MV, Timmermans JP, Michaels L, Liang J, Qiu JP, Van de Heyning P. Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians. Adv Otorhinolaryngol. 2007;65:6-16. DOI: https://doi.org/10.1159/000098663.
Rudic M, Keogh I, Wagner R, Wilkinson E, Kiros N, Ferrary E, Sterkers O, Bozorg Grayeli A, Zarkovic K, Zarkovic N. The pathophysiology of otosclerosis: Review of current research. Hear Res. 2015 Dec;330(Pt A):51-6. DOI: https://doi.org/10.1016/j.heares.2015.07.014.
Chole RA, McKenna M. Pathophysiology of otosclerosis. Otol Neurotol. 2001 Mar;22(2):249-57. DOI: https://doi.org/10.1097/00129492-200103000-00023. PMID: 11300278.
Zukić B, Anđelković M, Gašić V, Grubin J, Pavlović S, Đerić D. Genetic basis of otosclerosis. Srpski Arhiv za Celokupno Lekarstvo. 2020;148: 621–625.
Quesnel AM, Ishai R, McKenna MJ. Otosclerosis: Temporal Bone Pathology. Otolaryngol Clin North Am. 2018 Apr;51(2):291-303. DOI: https://doi.org/10.1016/j.otc.2017.11.001. Epub 2018 Feb 3.
Persson P, Harder H, Magnuson B. Hearing results in otosclerosis surgery after partial stapedectomy, total stapedectomy and stapedotomy. Acta Otolaryngol. 1997 Jan;117(1):94-9. DOI: https://doi.org/10.3109/00016489709117998.
Ahmad M, Chari DA, McKenna MJ, Quesnel AM. Mixed and Sensorineural Hearing Loss in Otosclerosis: Incidence, Pathophysiology, and Treatment. Current Otorhinolaryngology Reports. 2022;10:8-15.
Salem M, Wishahi H, Abd El-Raziq M, Asham M. Endoscopic Versus Microscopic Stapedectomy For Treatment of Otosclerosis. Egypt J Neck Surg Otorhinolaryngol. 2019;5(2):28-39. DOI: https://doi.org/10.21608/ejnso.2019.57906.
Kojima H, Komori M, Chikazawa S, Yaguchi Y, Yamamoto K, Chujo K, Moriyama H. Comparison between endoscopic and microscopic stapes surgery. Laryngoscope. 2014 Jan;124(1):266-71. DOI: https://doi.org/10.1002/lary.24144. Epub 2013 May 13.
Iannella G, Magliulo G. Endoscopic Versus Microscopic Approach in Stapes Surgery: Are Operative Times and Learning Curve Important for Making the Choice? Otol Neurotol. 2016 Oct;37(9):1350-7. DOI: https://doi.org/10.1097/MAO.0000000000001186.
Cheng HCS, Agrawal SK, Parnes LS. Stapedectomy Versus Stapedotomy. Otolaryngol Clin North Am. 2018 Apr;51(2):375-392. DOI: https://doi.org/10.1016/j.otc.2017.11.008.
Thamjarayakul T., Supiyaphun P., Snidvongs K..Cirugía de fijación del estribo: estapedectomía versus estapedotomía. Biomedicina asiática. 2010;4(3): 429-434. https://doi.org/10.2478/abm-2010-0052
House HP, Hansen MR, Al Dakhail AA, House JW. Stapedectomy versus stapedotomy: comparison of results with long-term follow-up. Laryngoscope. 2002;112(11):2046-50. DOI: https://doi.org/10.1097/00005537-200211000-00025.
Dundar R, Iynen I, Buyruk A. Different approach for surgery of stapes: Comparison microscopic and endoscopic approach. Am J Otolaryngol. 2022 Jan-Feb;43(1):103242. DOI: https://doi.org/10.1016/j.amjoto.2021.103242IF: 2.5 Q2. Epub 2021 Sep 16. PMID: 34543947IF: 2.5 Q2 .
Harikumar B, Arun Kumar KJ. Comparative study between microscopic and endoscopic stapes surgery. Int J Otorhinolaryngol Head Neck Surg. 2017;3(2):285. https://doi.org/10.18203/issn.2454-5929.ijohns20171179
Plodpai Y. The utility and safety of diode laser in endoscopic stapes surgery. Laryngoscope Investig Otolaryngol. 2023 Mar 23;8(2):561-567. DOI: https://doi.org/10.1002/lio2.1045IF: 1.9 Q3 . PMID: 37090885IF: 1.9 Q3; PMCID: PMC10116957IF: 1.9 Q3 .
Moneir W, Eladl HM, El-Okda MM, Ebada HA. Chorda tympani injury during endoscopic versus microscopic stapes surgery: a randomized controlled clinical trial. Eur Arch Otorhinolaryngol. 2023 Feb;280(2):689-693. DOI: https://doi.org/10.1007/s00405-022-07550-0.
Armenta-villanueva RM, Santos-mejía FPBL. Experiencia en el tratamiento quirúrgico de la otoesclerosis. Rev Espec Med Quir. 2019;24:30–9.
Kageyama-Escobar AM, Tornero-Villegas KI, Vivar-Acevedo E, Ceballos-Lizarraga R, Torres-Valenzuela A, Vargas-Aguayo AM. Evaluación audiológica de la técnica de estapedectomía con prótesis de Schuknecht en pacientes con otoesclerosis. Cir Cir. 2001;69(6):286-290.
Rodríguez-Quintana OS, Lugo-Machado JA, Méndez-Cázares JA, Zavala-Contreras N, Vargas-Cárdenas LG, Rubio-Espinoza AA. et al. Resultados audiológicos en cirugía de estribo por otosclerosis en un centro de tercer nivel del noroeste de México. Re med Clin.. 2020;4(2):73–78.
Lira R Karina, Rosenbaum F Andrés, García-Huidobro N Francisco, Astudillo S Jorge, Huidobro D Bárbara, Caro L Jorge et al . Resultados auditivos del tratamiento quirúrgico de la otoesclerosis en el Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile. Rev. Otorrinolaringol. Cir. Cabeza Cuello. 2019;79( 4 ): 421-427. DOI: https://doi.org/ http://dx.doi.org/10.4067/S0718-48162019000400421.28.
Socha Gonzalez M, Macías-Tolosa C, Martínez H. Experiencia en estapedotomía en el Hospital Universitario Clínica San Rafael entre 2018 y 2019. Acta Otorrinolaringol Cir Cabeza Cuello 2020;48(3):213–7. https://doi.org/10.37076/acorl.v48i3.490
Fan CJ, Kaul VF, Mavrommatis MA, Schwam ZG, Hu S, Kong DK, Phan NM, Villavisanis DF, Cosetti MK, Wanna GB. Endoscopic Versus Microscopic Stapedotomy: A Single-Blinded Randomized Control Trial. Otol Neurotol. 2021 Dec 1;42(10):1460-1466. DOI: https://doi.org/10.1097/MAO.0000000000003298
Das A, Mitra S, Ghosh D, Sengupta A. Endoscopic Stapedotomy: Overcoming Limitations of Operating Microscope. Ear Nose Throat J. 2021 Feb;100(2):103-109. DOI: https://doi.org/10.1177/0145561319862216.
Koukkoullis A, Tóth I, Gede N, Szakács Z, Hegyi P, Varga G, Pap I, Harmat K, Németh A, Szanyi I, Lujber L, Gerlinger I, Révész P. Endoscopic versus microscopic stapes surgery outcomes: A meta-analysis and systematic review. Laryngoscope. 2020 Aug;130(8):2019-2027. DOI: https://doi.org/10.1002/lary.28353. Epub 2019 Nov 12.
Ho S, Patel P, Ballard D, Rosenfeld R, Chandrasekhar S. Systematic Review and Meta-analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation. Otolaryngol Head Neck Surg. 2021 Nov;165(5):626-635. DOI: https://doi.org/10.1177/0194599821990669. Epub 2021 Feb 2.
Fang L, Xu J, Wang W, Huang Y. Would endoscopic surgery be the gold standard for stapes surgery in the future? A systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2021 Apr;278(4):925-932. DOI: https://doi.org/10.1007/s00405-020-06132-2.
Surmelioglu O, Ozdemir S, Tarkan O, Tuncer U, Dagkiran M, Cetik F. Endoscopic versus microscopic stapes surgery. Auris Nasus Larynx. 2017 Jun;44(3):253-257. DOI: https://doi.org/10.1016/j.anl.2016.07.001
Manna S, Kaul VF, Gray ML, Wanna GB. Endoscopic Versus Microscopic Middle Ear Surgery: A Meta-analysis of Outcomes Following Tympanoplasty and Stapes Surgery. Otol Neurotol. 2019 Sep;40(8):983-993. DOI: https://doi.org/10.1097/MAO.0000000000002353.
Verde-Lizárraga, C., Lugo-Machado, J. A., Sainz-Fuentes, N., Quintero-Bauman, A., Jiménez-Rodríguez, M., Canche-Martín, E. M., & Reina-Loaiza, J. R. (2023). Hearing gain in patients undergoing stapes surgery for otosclerosis. Revista ORL, 15(1), e31680. https://doi.org/10.14201/orl.31680
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