A comparative study of results of stapedotomy and neo-stapedotomy as a surgical treatment for otosclerosis
Keywords:Neo-stapedotomy, Stapedotomy, Stapedial reflex, Speech discrimination score, Loudness discomfort level
Background: The aim of the study was to establish the usefulness of preservation of the stapedius tendon and the incudo-stapedial joint during the surgical procedure for the treatment of otosclerosis, to find out the advantages of neo-stapedotomy over standard stapedotomy and to compare the hearing improvement in neo-stapedotomy and stapedotomy.
Methods: A prospective, randomised, controlled study with a sample size of 150 patients (ears) presented with pure conductive deafness, paracusis willisii and tinnitus was done. The patients were divided in to group A (n=60) &and group B (n=90), where neo-stapedotomy and standard stapedotomy procedure were performed respectively. Pure tone audiometry and tympanometry were done both pre and postoperatively. Speech discrimination score (SDS) and loudness discomfort levels (LDL) were measured at 3 months postoperatively.
Results: Postoperative hearing improvement in both groups was almost identical. Improvement in middle ear compliance was marginally more in group A patients. Stapedial reflex could be elicited in 72 % of the patients in group A, but remained absent in group B, at 3 month post-operatively. The SDS became worse with more than 20 dB suprathreshold sounds in group B patients whereas it was maintained even with 80 dB in most patients of group A. Post-operative mean LDL for both pure tone and speech frequency in group A patients were higher than those in group B.
Conclusions: The difference of SDS and LDL between two groups were statistically significant. Hence, neo-stapedotomy is a better procedure, as no postoperative pseudo-recruitment ‘rollover’ observed and also dynamic range of hearing increased.
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