Management of advanced otosclerosis: experience in a tertiary care centre

Mohammed Iftekharul Alam, Kiran Natarajan, Takhellambam Biram Singh, Abha Kumari, Mohan Kameswaran


Background: Advanced otosclerosis affects approximately 10% of patients with otosclerosis. Ossification of the cochlea increases with the course of the disease and may cause sensori-neural or mixed hearing loss. Hearing aids, stapedotomy and cochlear implants are management options for hearing loss associated with advanced otosclerosis.

Methods: A retrospective study of 153 patients with advanced otosclerosis was done in a tertiary ENT centre. 110 patients with advanced otosclerosis underwent stapedotomy and 43 patients with advanced otosclerosis underwent cochlear implantation (CI) from 1997 till date. Exclusion criteria included patients with profound hearing loss from causes other than otosclerosis. The aim was to study the indications, selection criteria, as well as surgical issues of stapedotomy and cochlear implantation in patients with advanced otosclerosis.  

Results: Stapedotomy followed by use of hearing aid was found to give good outcomes in advanced otosclerosis. Patients with advanced otosclerosis who had poor pre-operative speech discrimination underwent CI. Complete insertion was possible in 39 patients and partial insertion was done in 4 patients. The outcomes of cochlear implantation were found to be satisfactory. Facial nerve stimulation was seen in 5 patients who underwent CI; however this was successfully managed by reprogramming or switching off the concerned electrodes.

Conclusions: In our experience, stapedotomy or CI in advanced otosclerosis has proven successful, with a low complication rate. The selection criteria for stapedotomy versus CI have to be stringent for optimal outcomes.


Advanced otosclerosis, Stapedotomy, Cochlear implantation

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Semaan MT, Gehani NC, Tummala N, Coughlan C, Fares SA, Hsu DP, et al. Cochlear implantation outcomes in patients with far advanced otosclerosis. Am J Otolaryngol. 2012;33(5):608-14.

Archbold S, Lutman ME, Nikolopoulos T. Categories of auditory performance: inter-user reliability. Br J Audiol. 1998;32(1):7-12.

Merkus P, van Loon MC, Smit CF, Smits C, de Cock AF, Hensen EF. Decision making in advanced otosclerosis: an evidence-based strategy. Laryngoscope. 2011;121(9):1935-41.

Castillo F, Polo R, Gutiérrez A, Reyes P, Royuela A, Alonso A. Cochlear implantation outcomes in advanced otosclerosis. Am J Otolaryngol. 2014;35(5):558-64.

Calmels MN, Viana C, Wanna G, Marx M, James C, Deguine O, Fraysse B. Very far-advanced otosclerosis: stapedotomy or cochlear implantation. Acta Otolaryngol. 2007;127(6):574-8.

van Loon MC, Merkus P, Smit CF, Smits C, Witte BI, Hensen EF. Stapedotomy in cochlear implant candidates with far advanced otosclerosis: a systematic review of the literature and meta-analysis. Otol Neurotol. 2014;35(10):1707-14.

Psillas G, Kyriafinis G, Constantinidis J, Vital V. Far-advanced otosclerosis and cochlear implantation. B-ENT. 2007;3(2):67-71.

Burmeister J, Rathgeb S, Herzog J. Cochlear implantation in patients with otosclerosis of the otic capsule. Am J Otolaryngol. 2017;38(5):556-9.