Far advanced otosclerosis: Stapes surgery or cochlear implantation?

Objective: Nowadays, two surgical alternatives are to be considered in patients with far advanced otosclerosis: stapedectomy and cochlear implantation. The aim of this study was to analyze and compare the hearing and communicative results obtained in two groups of patients affected with far advanced otosclerosis, who were treated with the two different surgical procedures, to assess the proper surgical approach for these patients. Design: Retrospective study. Settings: University hospital and referral audiologic centre. Methods: We submitted 11 adult patients, affected by far advanced otosclerosis and exhibiting unsatisfactory communicative abilities with hearing aids, to two different procedures: 5 to cochlear implantation. and 6 to stepedotomy followed by hearing aid fitting. The benefits afforded by the two procedures were assessed by means of pure-tone audiometry and speech audiometry in an open field and by means of a speech perception test. Main Outcome Measures: Hearing and communicative outcomes, measured I year after intervention. Results: The results achieved in the patients subjected to stapedotomy were unpredictable and variable: very good in some cases but unsatisfactory in others, whereas those who had cochlear implantation all achieved satisfactory, results with regard to speech recognition. Conclusions: Patients who underwent cochlear implantation achieved better hearing and communicative results than those who underwent stapedotomy. Even if the number of patients reported in this study is too small to provide definitive results. and despite the reportedly better results afforded by cochlear implantation,. in our opinion, correction of far advanced otosclerosis should first be attempted via stapedotomy, and cochlear implantation should instead be reserved for cases in which stapedotomy is unsuccessful or for which imaging techniques unequivocally reveal a fenestral or cochlear obstruction.