Modified Power Piston Versus Simultaneous Stapedotomy With Hearing Aids in Otosclerosis: A Follow-Up Study Exploring Speech Recognition, Quality of Life and Usage of Device

Abstract

Objective: To compare audiologic outcomes, quality-of-life (QoL) and usage-of-device (UoD) between case-matched, otosclerotic patients with mixed hearing loss (MHL) which received (a) stapedotomy and postoperative amplification with hearing aids (SDT+HA) or (b) short-incudial process coupled active middle ear implant with simultaneous stapedotomy (mPP).

Study design, setting, and patients: Prospective, matched case-control, follow-up study conducted at two tertiary otologic referral centers. Eligible were all otosclerotic patients with MHL, which received mPP at either of the two institutions. A case-matched-cohort of SDT+HA-patients was generated from the hospitals database based on preoperative audiologic findings.

Main outcome measures: For sound- and speech perception, primary outcome parameters were the mean postoperative, aided air-conduction pure tone average (mpa-AC-PTA) and word recognition score at 80 dB speech level (mpa-WRS), for QoL the mean Nijmegen-Cochlear-Implant-Questionnaire (NCIQ) total-score, and for UoD the mean score rated on a 10-point Likert-scale.

Results: A total of 28 patients were included; 14 received mPP; mpa-AC-PTA and mpa-WRS significantly improved from 47.1 dB-HL to 34.3 dB-HL (-12.8 dB-HL; p < 0.001) and from 75.0% to 93.2% (+18.2%; p = 0.002) compared to 46.5 dB-HL to 31.9 dB-HL (-14.8 dB-HL; p < 0.008) and 75.0% to 93.2% (+18.2%; p = 0.002) for SDT+HA. No significant difference between groups was observed (all p > 0.1). NCIQ total-score between groups did not significantly differ (70.4 vs. 69.9; p = 0.93). UoD for mPP was significantly higher (6.1 vs. 3.0; p < 0.001).

Conclusions: If medical/technical problems prevent usage of HA in otosclerosis with MHL, mPP can be considered as effective treatment option with similar audiological outcome and QoL. A significantly higher UoD for mPP was observed.

FIG. 1

“Mean postoperative unaided and aided air-conductive pure tone average for patients undergoing modified power piston surgery or conventional stapedotomy with postoperative fitting of hearing aids.” Mean postoperative unaided (left side of the diagram) and aided (right side of the diagram) pure tone averages (PTA) measured via air-conduction (AC). Patients undergoing modified power piston surgery (mPP) are depicted in the upper part of the diagram, patients undergoing conventional stapedotomy with postoperative fitting of hearing aids (SDT) are depicted in the lower half of the diagram. For standard deviations, ranges, f- and Z-values refer to main text. In terms of sound perception, a benefit for mPP- and SDT-patients was observed after activation of VSB/HA (−12.8 vs. −14.8 dB-HL). However, neither the difference between the change nor between the mean postoperative aided AC-PTA significantly differed (p = 0.114 and p = 0.439, respectively).

FIG. 2

“Mean postoperative unaided and aided word recognition score at 80 decibel sound pressure level for patients undergoing modified power piston surgery or conventional stapedotomy with postoperative fitting of hearing aids.” Mean postoperative unaided (left side of the diagram) and aided (right side of the diagram) word recognition score (WRS) measured at 80 decibel (dB) sound pressure level (SPL). Patients undergoing modified power piston surgery (mPP) are depicted in the upper part of the diagram, patients undergoing conventional stapedotomy with postoperative fitting of hearing aids (SDT) are depicted in the lower half of the diagram. For standard deviations, ranges, f- and Z-values refer to main text. In terms of speech perception, an improvement for mPP- and SDT-patients was observed after activation of the AMEI audio processor or the HA (+18.2 vs. +15.0%). Neither the difference between the change nor between the mean postoperative aided WRS at 80 dB speech level significantly differed (p = 0.059 and p = 0.179, respectively).