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. 2021 Jun 11;6(4):824-831.
doi: 10.1002/lio2.599. eCollection 2021 Aug.

Does stapedotomy improve high frequency conductive hearing?

Prithwijit Roychowdhury  1   2 , Marc D Polanik  1   2 , Judith S Kempfle  1   3 , Melissa Castillo-Bustamante  1   4 , Cheryl Fikucki  5 , Michael J Wang  2 , Elliott D Kozin  1   4 , Aaron K Remenschneider  1   2   3   4   5
Affiliations

Does stapedotomy improve high frequency conductive hearing?

Prithwijit Roychowdhury et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: Stapedotomy is performed to address conductive hearing deficits. While hearing thresholds reliably improve at low frequencies (LF), conductive outcomes at high frequencies (HF) are less reliable and have not been well described. Herein, we evaluate post-operative HF air-bone gap (ABG) changes and measure HF air conduction (AC) thresholds changes as a function of frequency.

Methods: Retrospective review of patients who underwent primary stapedotomy with incus wire piston prosthesis between January 2016 and May 2020. Pre- and postoperative audiograms were evaluated. LF ABG was calculated as the mean ABG of thresholds at 250, 500, and 1000 Hz. HF ABG was calculated at 4 kHz.

Results: Forty-six cases met criteria. Mean age at surgery was 54.0 ± 11.7 years. The LF mean preoperative ABG was 36.9 ± 11.0 dB and postoperatively this significantly reduced to 9.35 ± 6.76 dB, (P < .001). The HF mean preoperative ABG was 31.1 ± 14.4 dB and postoperatively, this also significantly reduced to 14.5 ± 12.3 dB, (P < .001). The magnitude of LF ABG closure was over 1.5 times the magnitude of HF ABG closure (P < .001). The gain in AC decreased with increasing frequency (P < .001).

Conclusion: Hearing improvement following stapedotomy is greater at low than high frequencies. Postoperative air bone gaps persist at 4 kHz. Further biomechanical and histopathologic work is necessary to localize postoperative high frequency conductive hearing deficits and improve stapedotomy hearing outcomes.

Level of evidence: 4, retrospective study.

Keywords: conductive hearing loss; hearing loss; high‐frequency hearing loss; otosclerosis; stapedotomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Pre and postoperative ABG changes (mean and 95% CI). ABG, air‐bone gap, AAO‐HNS = PTA4
FIGURE 2
FIGURE 2
Change in ABG by frequency (mean and 95% CI). ABG, air‐bone gap; LF, low‐frequency; HF, high‐frequency
FIGURE 3
FIGURE 3
Change in AC threshold by frequency (mean and 95% CI). AC, air conduction
FIGURE 4
FIGURE 4
Pre and postoperative WRS scattergrams per AAO‐HNS standards
See this image and copyright information in PMC

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