European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1111–1119 | Cite as

Long-term hearing results of stapedotomy: analysis of factors affecting outcome

  • Ingeborg Dhooge
  • Stéphanie Desmedt
  • Thomas Maly
  • David Loose
  • Helen Van Hoecke



To evaluate long-term hearing results of stapedotomy and analyze the influence of patient-, disease-, and procedure-related variables.

Study design

Retrospective case series.


Tertiary referral center.


230 ears (202 patients, 10–74 years) underwent stapedotomy for otosclerosis between January 2008 and August 2014. All cases had early postoperative follow-up (4 weeks post-surgery) and 181 cases had late postoperative follow-up (≥ 1 year, average 32.5 months).


Stapedotomy procedure for otosclerosis.

Main outcome measures

Hearing outcome using conventional audiometry. The primary outcome parameter was the postoperative air-bone gap pure-tone average. Postoperative air-bone gap ≤ 10 dB was defined as surgical success. Preoperative, early postoperative and late postoperative hearing results were compared. Influence of patient- and procedure-related variables on hearing outcome was evaluated by logistic regression analysis.


The postoperative air-bone gap was 10 dB or less in 77.0% of cases early post-surgery and in 70.7% of cases in long-term follow-up. Air-bone gap closure within 20 dB was obtained in 95.7 and 92.3%, respectively. Logistic regression analysis demonstrated that a larger preoperative air-bone gap (p = 0.041) and positive family history of otosclerosis (p = 0.044) were predictive for less surgical success early postoperatively, but not on the long term. Age, gender, primary versus revision surgery, presence of preoperative tinnitus and preoperative vertigo did not independently and significantly influence postoperative air-bone gap closure.


Our series confirms excellent hearing results achieved in stapedotomy surgery, also in long-term follow-up. On the long-term no patient-, disease-, or procedure-related variables were identified as predictors of surgical success.


Otosclerosis Stapedotomy Long-term Retrospective 



The authors would like to acknowledge Dr. Ellen Deschepper for statistical advice.

Compliance with ethical standards

Conflict of interest

Authors Ingeborg Dhooge, Stéphanie Desmedt, Thomas Maly, David Loose and Helen Van Hoecke have no conflict of interest.

Statement of human rights

The study has been approved by the Ethical Committee of Ghent University Hospital, Belgium (Approval Numbers: 2014- 0760/2014-0761 and 2015-0198/2015- 0199) and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. As is involved a retrospective study, formal consent is not required.

Supplementary material

405_2018_4899_MOESM1_ESM.tiff (41 kb)
Fig 1A: Preoperative and early postoperative Air Conduction extended Pure-Tone Average (AC-PTA) (n=230) (TIFF 40 KB)
405_2018_4899_MOESM2_ESM.tiff (41 kb)
Fig 1B: Preoperative and early postoperative Bone Conduction extended Pure-Tone Average (BC-PTA) (n=230) (TIFF 41 KB)
405_2018_4899_MOESM3_ESM.tiff (45 kb)
Fig 2A: Evolution of Air Conduction extended Pure-Tone Average (AC-PTA) from preoperative to early postoperative and late postoperative (n=181) (TIFF 45 KB)
405_2018_4899_MOESM4_ESM.tiff (28 kb)
Fig 2B: Evolution of Bone Conduction extended Pure-Tone Average (BC-PTA) from preoperative to early postoperative and late postoperative (n=181) (TIFF 28 KB)
405_2018_4899_MOESM5_ESM.docx (46 kb)
Supplementary material 5 (DOCX 45 KB)


  1. 1.
    Thomas JP, Minovi A, Dazert S (2011) Current aspects of etiology, diagnosis and therapy of otosclerosis. Otolaryngol Polska Polish Otolaryngol 65(3):162–170CrossRefGoogle Scholar
  2. 2.
    Ealy M, Smith RJ (2011) Otosclerosis. Adv Oto-Rhino-Laryngology 70:122–129CrossRefGoogle Scholar
  3. 3.
    Uppal S, Bajaj Y, Rustom I, Coatesworth AP (2009) Otosclerosis 1: the aetiopathogenesis of otosclerosis. Int J Clin Pract 63(10):1526–1530CrossRefPubMedGoogle Scholar
  4. 4.
    Cureoglu S, Schachern PA, Ferlito A, Rinaldo A, Tsuprun V, Paparella MM (2006) Otosclerosis: etiopathogenesis and histopathology. Am J Otolaryngol 27(5):334–340CrossRefPubMedGoogle Scholar
  5. 5.
    Schrauwen I, Van Camp G (2010) The etiology of otosclerosis: a combination of genes and environment. Laryngoscope 120(6):1195–1202PubMedGoogle Scholar
  6. 6.
    Marx M, Lagleyre S, Escude B, Demeslay J, Elhadi T, Deguine O et al (2011) Correlations between CT scan findings and hearing thresholds in otosclerosis. Acta Otolaryngol 131(4):351–357CrossRefPubMedGoogle Scholar
  7. 7.
    Liktor B, Szekanecz Z, Batta TJ, Sziklai I, Karosi T (2013) Perspectives of pharmacological treatment in otosclerosis. Eur Arch Oto-Rhino-Laryngology 270(3):793–804CrossRefGoogle Scholar
  8. 8.
    Goh CG, Tan WS, Yeo SB (2013) Hearing results of stapes surgery in Singapore and predictive factors affecting outcome. Ann Acad Med Singap 42(9):S158Google Scholar
  9. 9.
    Karosi T, Szekanecz Z, Sziklai I (2009) Otosclerosis: an autoimmune disease? Autoimmunity Rev 9(2):95–101CrossRefGoogle Scholar
  10. 10.
    Karosi T, Sziklai I (2010) Etiopathogenesis of otosclerosis. Eur Arch Oto-Rhino-Laryngol 267(9):1337–1349CrossRefGoogle Scholar
  11. 11.
    Niedermeyer HP, Arnold W, Neubert WJ, Sedlmeier R (2000) Persistent measles virus infection as a possible cause of otosclerosis: state of the art. Ear Nose Throat J 79(8):552–4, 6, 8 passimGoogle Scholar
  12. 12.
    Lescanne E, Bakhos D, Metais JP, Robier A, Moriniere S (2008) Otosclerosis in children and adolescents: a clinical and CT-scan survey with review of the literature. Int J Pediatr Otorhinolaryngol 72(2):147–152CrossRefPubMedGoogle Scholar
  13. 13.
    Niedermeyer HP, Arnold W. Otosclerosis and measles virus—association or causation? ORL J Oto-Rhino-Laryngol Relat Specialties 2008;70(1):63–69. (Discussion 9–70)CrossRefGoogle Scholar
  14. 14.
    Kishimoto M, Ueda H, Uchida Y, Sone M (2015) Factors affecting postoperative outcome in otosclerosis patients: predictive role of audiological and clinical features. Auris Nasus Larynx 42(5):369–373CrossRefPubMedGoogle Scholar
  15. 15.
    Strömback K et al. (2017) Stapes surgery in Sweden: evaluation of a national-based register. Eur Arch Otorhinolaryngol. (pMID: 28285424)PubMedPubMedCentralGoogle Scholar
  16. 16.
    Spandow O, Söderberg O, Bohlin L (2000) ong-term results in otosclerotic patients operated by stapedectomy or stapedotomy. Scand Audiol 29(3):186–190. (PubMed PMID: 10990017)CrossRefPubMedGoogle Scholar
  17. 17.
    Hearing Co (1995) Equilibrium. Committee on hearing and equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 113(3):186–187CrossRefGoogle Scholar
  18. 18.
    Vincent R, Sperling NM, Oates J, Jindal M (2006) Surgical findings and long-term hearing results in 3050 stapedotomies for primary otosclerosis: a prospective study with the otology-neurotology database. Otol Neurotol 27(8 Suppl 2):S25-47PubMedGoogle Scholar
  19. 19.
    de Bruijn AJ, Tange RA, Dreschler WA (2001) Efficacy of evaluation of audiometric results after stapes surgery in otosclerosis. II. A method for reporting results from individual cases. Otolaryngol Head Neck Surg 124(1):84–89CrossRefPubMedGoogle Scholar
  20. 20.
    Gurgel RK, Popelka GR, Oghalai JS, Blevins NH, Chang KW, Jackler RK (2012) Is it valid to calculate the 3-kilohertz threshold by averaging 2 and 4 kilohertz?. Otolaryngol Head Neck Surg 147(1):102–104CrossRefPubMedGoogle Scholar
  21. 21.
    Kisilevsky VE, Dutt SN, Bailie NA, Halik JJ (2009) Hearing results of 1145 stapedotomies evaluated with Amsterdam hearing evaluation plots. J Laryngol Otol 123(7):730–736CrossRefPubMedGoogle Scholar
  22. 22.
    Kisilevsky V, Bailie NA, Halik JJ (2010) Bilateral hearing results of 751 unilateral stapedotomies evaluated with the Glasgow benefit plot. J Laryngol Otol 124(5):482–489CrossRefPubMedGoogle Scholar
  23. 23.
    Kisilevsky VE, Bailie NA, Halik JJ (2010) Results of stapedotomy in otosclerosis with severe and profound hearing loss. J Otolaryngol Head Neck Surg 39(3):244–252PubMedGoogle Scholar
  24. 24.
    Marchese MR, Conti G, Cianfrone F, Scorpecci A, Fetoni AR, Paludetti G (2009) Predictive role of audiological and clinical features for functional results after stapedotomy. Audiol Neuro-otol 14(5):279–285CrossRefGoogle Scholar
  25. 25.
    Kos MI, Montandon PB, Guyot JP (2001) Short- and long-term results of stapedotomy and stapedectomy with a teflon-wire piston prosthesis. Ann Otol Rhinol Laryngol 110(10):907–911CrossRefPubMedGoogle Scholar
  26. 26.
    House HP, Hansen MR, Al Dakhail AAA, House JW (2002) Stapedectomy versus stapedotomy: comparison of results with long-term follow-up. Laryngoscope 112(11):2046–2050CrossRefPubMedGoogle Scholar
  27. 27.
    Souza JC, Bento RF, Pereira LV, Ikari L, Souza SR, Della Torre AA et al (2016) Evaluation of functional outcomes after stapes surgery in patients with clinical otosclerosis in a teaching institution. Int Arch Otorhinolaryngol 20(1):39–42PubMedGoogle Scholar
  28. 28.
    Bittermann AJ, Rovers MM, Tange RA, Vincent R, Dreschler WA, Grolman W (2011) Primary stapes surgery in patients with otosclerosis: prediction of postoperative outcome. Arch Otolaryngol Head Neck Surg 137(8):780–784CrossRefPubMedGoogle Scholar
  29. 29.
    Babighian GG, Albu S (2009) Failures in stapedotomy for otosclerosis. Otolaryngol Head Neck Surg 141(3):395–400CrossRefPubMedGoogle Scholar
  30. 30.
    Aarnisalo AA, Vasama JP, Hopsu E, Ramsay H (2003) Long-term hearing results after stapes surgery: a 20-year follow-up. Otol Neurotol 24(4):567–571CrossRefPubMedGoogle Scholar
  31. 31.
    Ayache D, Earally F, Elbaz P (2003) Characteristics and postoperative course of tinnitus in otosclerosis. Otol Neurotol 24(1):48–51CrossRefPubMedGoogle Scholar
  32. 32.
    de Bruijn AJ, Tange RA, Dreschler WA (2001) Efficacy of evaluation of audiometric results after stapes surgery in otosclerosis. I. The effects of using different audiologic parameters and criteria on success rates. Otolaryngol Head Neck Surg 124(1):76–83Google Scholar
  33. 33.
    Wegner I, Verhagen JJ, Stegeman I, Vincent R, Grolman W (2016) A systematic review of the effect of piston diameter in stapes surgery for otosclerosis on hearing results. Laryngoscope 126(1):182–190Google Scholar
  34. 34.
    Yung MW, Oates J (2007) The learning curve in stapes surgery and its implication for training. Adv Oto-Rhino-Laryngol 65:361–369CrossRefGoogle Scholar
  35. 35.
    Loewenthal M, Jowett N, Busch CJ, Knecht R, Dalchow CV (2015) A comparison of hearing results following stapedotomy under local versus general anesthesia. Eur Arch Otorhinolaryngol 272(9):2121–2127CrossRefPubMedGoogle Scholar
  36. 36.
    Moscillo L, Imperiali M, Carra P, Catapano F, Motta G (2006) Bone conduction variation poststapedotomy. Am J Otolaryngol Head Neck Med Surg 27(5):330–333Google Scholar
  37. 37.
    Dornhoffer JL, Bailey HA Jr, Graham SS (1994) Long-term hearing results following stapedotomy. Am J Otol 15(5):674–678PubMedGoogle Scholar
  38. 38.
    Shin YJ et al (2001) Sensorineural hearing loss and otosclerosis: a clinical and radiologic survey of 437 cases. Acta Otolaryngol 121(2):200–204. (PMID:11349779)CrossRefPubMedGoogle Scholar
  39. 39.
    Koopmann M, Weiss D, Savvas E, Rudack C, Stenner M (2015) Outcome measures in stapes surgery: postoperative results are independent from preoperative parameters. Eur Arch Otorhinolaryngol 272(9):2175–2181CrossRefPubMedGoogle Scholar
  40. 40.
    Kashio A, Ito K, Kakigi A, Karino S, Iwasaki S, Sakamoto T et al (2011) Carhart notch 2-kHz bone conduction threshold dip: a nondefinitive predictor of stapes fixation in conductive hearing loss with normal tympanic membrane. Arch Otolaryngol Head Neck Surg 137(3):236–240CrossRefPubMedGoogle Scholar
  41. 41.
    Karimi Yazdi A, Sazgar AA, Motiee M, Ashtiani MK (2009) Improvement of bone conduction after stapes surgery in otosclerosis patients with mixed hearing loss depending from surgical technique. Eur Arch Otorhinolaryngol 266(8):1225–1228CrossRefPubMedGoogle Scholar
  42. 42.
    Gristwood RE, Venables WN (2013) Analysis of long-term hearing gains after stapes surgery with piston reconstruction for otosclerosis. Ann Otol Rhinol Laryngol 122(8):500–510CrossRefPubMedGoogle Scholar
  43. 43.
    Gurgel RK, Oghalai JS, Chang KW, Blevins NH, Jackler RK, Popelka RK (2011) Correlation of measured vs averaged 3 kHz pure tone averages. Otolaryngology Head Neck Surg 145(2 suppl):P90CrossRefGoogle Scholar
  44. 44.
    Gersdorff M, Nouwen J, Gilain C, Decat M, Betsch C (2000) Tinnitus and otosclerosis. Eur Arch Oto-Rhino-Laryngol 257(6):314–316CrossRefGoogle Scholar
  45. 45.
    Lima Ada S, Sanchez TG, Marcondes R, Bento RF (2005) The effect of stapedotomy on tinnitus in patients with otospongiosis. Ear Nose Throat J 84(7):412–414PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyGhent UniversityGhentBelgium
  2. 2.Department of OtorhinolaryngologyGhent University HospitalGhentBelgium
  3. 3.Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium

Personalised recommendations