Decisive Criteria Between Stapedotomy and Cochlear Implantation in Patients with Far Advanced Otosclerosis

作者：Kabbara Bilal^*; Gauche Clement; Calmels Marie Noelle; Lepage Benoit; Escude Bernard; Deguine Olivier; Fraysse Bernard; Marx Mathieu

来源：Otology & Neurotology, 2015, 36(3): E73-E78.

DOI：10.1097/mao.0000000000000692

• Cochlear implant
• Facial nerve stimulation
• Far-advanced otosclerosis
• Stapedotomy

Objectives: 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.
Study Design: Retrospective case review.
Setting: Academic neurotology tertiary referral center.
Patients: All patients (n = 58) with preoperative air conduction PTA less than 85dB (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.
Interventions: Stapedotomy, cochlear implantation, or both.
Main Outcome Measures: 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.
Conclusion: 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.

• 出版日期2015-3