Stapedotomy in Cochlear Implant Candidates With Far Advanced Otosclerosis: A Systematic Review of the Literature and Meta-analysis

Objective: To evaluate the effect of stapedotomy in cochlear implant candidates with far-advanced otosclerosis (FAO). Design: Systematic review of literature and meta-analysis. Data sources: PubMed, EMBASE, and Cochrane databases were searched for "stapedotomy'' and "far-advanced otosclerosis'' and their synonyms. The search was carried out on November 28, 2013; no language restrictions were applied. Study selection: The initial search yielded 243 articles; a total of nine articles met our inclusion criteria (i.e., patients with FAO and aided speech recognition scores of <= 50%) and were included in this review. In addition, a group of five patients (seven stapedotomies) of our own center was also included in this meta-analysis. Data extraction: The methodologic quality of included studies was assessed by examining the study design, level of evidence, method of measurement, and adequacy of outcome reporting. The speech recognition scores before and after stapedotomy as well as the pure-tone average before and after stapedotomy were extracted. Data synthesis: A random-effects model was fitted for calculating weighted means. The mean preoperative speech recognition score was 11%; stapedotomy resulted in a mean postoperative speech recognition score of 59%. The mean preoperative and postoperative pure-tone averages were 112 dB HL and 80 dB HL, respectively. Seventy-two percent of the patients no longer met the criterion for cochlear implantation (CI) (i.e., <50% speech recognition), and 35% of the patients reached a postoperative aided speech recognition of more than 80%. Conclusion: Stapedotomy combined with hearing aid fitting results in a good outcome in a substantial amount of CI candidates with FAO. We feel that a stapedotomy should be attempted before considering CI in all patients with FAO. In patients with bilateral otosclerosis, a contralateral stapedotomy may offer patients the benefits of binaural processing. If bilateral stapedotomy yields an unsatisfactory outcome, the option for CI is still open.