Surgical options for advanced otosclerosis

Objective. Management of advanced otosclerosis (AO) has evolved over the past 20 years with the availability of cochlear implant (CI) in addition to stapes surgery. Both procedures are reliable treatment options for AO with similar success rates and currently there are no standard guidelines regarding the surgical treatment of AO. The aim of this paper is to report the outcomes and complications of a series of patients with AO submitted to CI at our Institution. An extensive review of the literature is also provided. Methods. The study group was composed of 31 adult patients affected by AO, consecutively submitted to CI at our Institution. Postoperative results and complications were compared to those of a homogeneous control group of adult implanted patients, affected by post-verbal sensorineural hearing loss due to other aetiologies. Results. Patients in both groups achieved satisfactory results in terms of speech perception in quiet and with background noise after CI, without no significant differences. The rate of complications in the study group was 15%, which is similar to literature reports. Conclusions. In patients with AO, the decision between stapes surgery and CI must be personalised and well-considered, taking into account the individual characteristics of the patient and the potential risks and benefits of each option.