Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2025
Assessing Risk of Stapedectomy in Patients With Otosclerosis and Semicircular Canal Dehiscence.
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Sperling Neil M, Adams Matthew D, Kumaev Boris, Haberman Jona
Аннотация
OBJECTIVE: To investigate the effect of semicircular canal dehiscence (SCD) on surgical outcomes in patients with otosclerosis.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary referral center.
PATIENTS: Eighteen patients were identified with concomitant, clinically suspected otosclerosis and radiographic SCD. Eight patients underwent primary stapes surgery, 2 underwent revision stapes surgery, 6 were advised against surgery, and 2 patients were evaluated after unsuccessful stapes surgery done elsewhere and had worsened hearing or unmasked third-window symptoms. Some patients were not offered stapes surgery due to presumed higher risk.Intervention(s):Review audiometric, and radiographic evaluations of patients who were diagnosed with both otosclerosis and SCD.Main outcome measure(s):Preoperative and postoperative audiometry, radiographically measured approximate dehiscence area (ADA), and symptoms in patients with otosclerosis and semicircular canal dehiscence were evaluated.
RESULTS: Six of 8 (75%) primary stapedotomy patients had closure of the air-bone gap (ABG) to <10 dB, while 1 patient had >20 dB ABG. Both revision stapedotomy patients had >20 dB ABG postoperatively. No patients operated by the authors reported unmasking of third-window symptoms after stapes surgery. ADA was not significantly different in patients in the unoperated versus primary/revision stapes surgery group. One patient who had a present cVEMP threshold did not close their ABG after stapes surgery, whereas 2 patients with absent cVEMP thresholds did.
CONCLUSIONS: In select patients, stapes surgery can result in improved hearing when otosclerosis and SCD coexist. Measurements of dehiscence area were not shown to predict surgical outcomes. CT imaging combined with VEMP testing appear to be valuable tools to assess risk of stapes surgery.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary referral center.
PATIENTS: Eighteen patients were identified with concomitant, clinically suspected otosclerosis and radiographic SCD. Eight patients underwent primary stapes surgery, 2 underwent revision stapes surgery, 6 were advised against surgery, and 2 patients were evaluated after unsuccessful stapes surgery done elsewhere and had worsened hearing or unmasked third-window symptoms. Some patients were not offered stapes surgery due to presumed higher risk.Intervention(s):Review audiometric, and radiographic evaluations of patients who were diagnosed with both otosclerosis and SCD.Main outcome measure(s):Preoperative and postoperative audiometry, radiographically measured approximate dehiscence area (ADA), and symptoms in patients with otosclerosis and semicircular canal dehiscence were evaluated.
RESULTS: Six of 8 (75%) primary stapedotomy patients had closure of the air-bone gap (ABG) to <10 dB, while 1 patient had >20 dB ABG. Both revision stapedotomy patients had >20 dB ABG postoperatively. No patients operated by the authors reported unmasking of third-window symptoms after stapes surgery. ADA was not significantly different in patients in the unoperated versus primary/revision stapes surgery group. One patient who had a present cVEMP threshold did not close their ABG after stapes surgery, whereas 2 patients with absent cVEMP thresholds did.
CONCLUSIONS: In select patients, stapes surgery can result in improved hearing when otosclerosis and SCD coexist. Measurements of dehiscence area were not shown to predict surgical outcomes. CT imaging combined with VEMP testing appear to be valuable tools to assess risk of stapes surgery.