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Otology & Neurotology : Official... Aug 2022This study aimed to establish hearing outcomes after cochlear implantation in patients with otosclerosis.
OBJECTIVE
This study aimed to establish hearing outcomes after cochlear implantation in patients with otosclerosis.
MATERIALS AND METHODS
We conducted a systematic review and narrative synthesis. Databases searched were as follows: MEDLINE, PubMed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov . No limits were placed on language or year of publication. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
RESULTS
Searches identified 474 abstracts and 180 full texts, with 68 studies meeting the inclusion criteria and reporting outcomes in a minimum of 481 patients with at least 516 implants. Patient-reported outcome measures (PROMs) were reported in five studies involving 51 patients. Intraoperative adverse events/surgical approach details and preoperative radiological assessment were reported in 46 and 38 studies, respectively. The methodological quality of included studies was modest, predominantly consisting of case reports and noncontrolled case series with small numbers of patients. Most studies were Oxford Centre for Evidence Based Medicine grade IV.
DISCUSSION
Access to good rehabilitation support is essential to achieving the good hearing outcomes and PROMs that can be expected by 12 months after implantation in most cases. There was a significant association between the radiological severity of otosclerosis and an increase in surgical and postoperative complications. Postoperative facial nerve stimulation can occur and may require deactivation of electrodes and subsequent hearing detriment.
CONCLUSIONS
Hearing outcomes are typically good, but patients should be counseled on associated surgical complications that may compromise hearing. Modern diagnostic techniques may help to identify potentially difficult cases to aid operative planning and patient counseling. Further work is needed to characterize PROMs in this population.
Topics: Cochlear Implantation; Cochlear Implants; Facial Nerve; Hearing; Humans; Otosclerosis
PubMed: 35861644
DOI: 10.1097/MAO.0000000000003574 -
JAMA Network Open Feb 2022Surgery and hearing aids have similar outcomes in terms of hearing acuity but differ in terms of cost, aesthetics, and patient quality of life. The cost-effectiveness...
IMPORTANCE
Surgery and hearing aids have similar outcomes in terms of hearing acuity but differ in terms of cost, aesthetics, and patient quality of life. The cost-effectiveness and budget impact of otosclerosis treatments have never been studied in Europe.
OBJECTIVES
To compare the estimated mean costs per patient over 10 years of surgery vs hearing aids for the treatment of otosclerosis and to estimate the budget impact of an increase in the proportion of patients receiving surgical treatment.
DESIGN, SETTING, AND PARTICIPANTS
This economic evaluation analyzed French and European epidemiological data on the surgical management of symptomatic otosclerosis and compared them with data from the literature to build economic models. The analysis was conducted in January 2021.
EXPOSURES
Two care pathways were considered in the treatment of otosclerosis, either hearing aid or surgery.
MAIN OUTCOMES AND MEASURES
Costs were studied over 10 years using Markov models of the 2 care pathways (hearing aid vs surgery). The budget impact analysis was performed over 5 and 10 years, assuming a 1-percentage point yearly increase in the proportion of patients receiving surgical treatment.
RESULTS
Over 10 years, the estimated mean cost per patient was significantly lower in the surgery group compared with the hearing aid group (€3446.9 vs €6088.4; mean difference, -€2641.5; 95% CI -€4064.8 to -€1379.4 [US $3913.4 vs US $6912.4; mean difference, -US $2999.0; 95% CI, -US $4614.9 to -US $1566.1]). Increasing surgical treatment by 1 percentage point per year for 10 years would lead to overall savings of €1 762 304 (US $2 000 798) in France, with an increase of €1 322 920 (US $1 501 952) at 10 years for the public health insurance system and a decrease of €3 085 224 (US $3 502 750) at 10 years for patients and private health insurers. Sensitivity analyses showed that these results were robust.
CONCLUSIONS AND RELEVANCE
These results suggest that in France, treating otosclerosis surgically is slightly less expensive over 10 years than using hearing aids, when considering all payers. The proposed models developed in this study could be adjusted to perform the same analysis in other countries.
Topics: Cost-Benefit Analysis; Europe; Hearing Aids; Humans; Markov Chains; Models, Economic; Otologic Surgical Procedures; Otosclerosis
PubMed: 35175343
DOI: 10.1001/jamanetworkopen.2021.48932 -
Auris, Nasus, Larynx Aug 2021Evidence from previous literature had shown that the use of a single frequency probe tone is not sensitive enough to detect middle ear pathologies, especially related to... (Comparative Study)
Comparative Study
OBJECTIVES
Evidence from previous literature had shown that the use of a single frequency probe tone is not sensitive enough to detect middle ear pathologies, especially related to the ossicles, which hinders accurate diagnosis. The goal of the present study was to compare the outcome of wideband absorbance (WBA) tympanometry and to determine the difference in WBA pattern in adults with otosclerosis and ossicular chain discontinuity.
MATERIALS AND METHODS
Estimated adult cases of otosclerosis (10 ears) and ossicular chain discontinuity (06 ears) along with healthy individuals (10 ears) in the age range of 24 to 48 years (mean age: 38.6 years) were considered for the study. WBA was measured at peak and ambient pressure along with resonance frequency and compared with the data obtained from the healthy individuals to determine the WBA pattern.
RESULTS
Data analysis revealed a distinct WBA pattern showing high absorbance at 750 Hz for ossicular chain discontinuity compared to healthy individuals, whereas the otosclerosis group showed reduced absorbance (p < 0.05) at low frequencies (250 Hz to 1500 Hz). WBA measured at the peak and ambient pressure did not elicit any significant difference across the frequencies. Also, the average WBA tympanogram measured between 375 Hz and 2000 Hz showed a significant difference in ambient pressure only in the otosclerosis group. In comparison to healthy individuals (901 Hz), ossicular chain discontinuity showed a significant reduction in resonance frequency (674 Hz), whereas in cases with otosclerosis had higher resonance frequency (1445 Hz).
CONCLUSIONS AND SIGNIFICANCE
The present study showed different WBA patterns between the groups and the absorbance values were significantly different at the low frequencies. This suggests that WBA has the potential to differentiate ossicles related pathologies from normal and also between the ear with otosclerosis and ossicular chain discontinuity.
Topics: Acoustic Impedance Tests; Acoustics; Adult; Auditory Threshold; Case-Control Studies; Ear Diseases; Ear Ossicles; Hearing Loss, Conductive; Humans; Middle Aged; Otosclerosis
PubMed: 33187789
DOI: 10.1016/j.anl.2020.10.019 -
BMJ Case Reports Apr 2016Otosclerosis in childhood and adolescence or juvenile otosclerosis is a rare disorder resulting in conductive hearing loss. A 9-year-old boy presented to our clinic,... (Review)
Review
Otosclerosis in childhood and adolescence or juvenile otosclerosis is a rare disorder resulting in conductive hearing loss. A 9-year-old boy presented to our clinic, suffering from moderate hearing loss. According to his parents, his hearing acuity had progressively deteriorated over the past 2 years. Otoscopy and tympanometry revealed bilateral secretory otitis media and the patient underwent bilateral grommet insertion. However, he continued to report of hearing loss and a right exploratory tympanotomy was performed. Stapedial fixation was confirmed, being compatible with juvenile otosclerosis, and we proceeded to a right stapedotomy. One year later, follow-up showed satisfactory outcome with an air-bone gap closure to 10 dB. Juvenile otosclerosis with the coexistence of persistent secretory otitis media can be overlooked. Affected children from 9 years of age are strongly motivated to undergo stapes surgery for juvenile otosclerosis, following parental consent.
Topics: Child; Hearing Loss, Conductive; Humans; Male; Otitis Media with Effusion; Otosclerosis; Stapes Surgery
PubMed: 27084899
DOI: 10.1136/bcr-2015-214232 -
Acta Oto-laryngologica Apr 2021Otosclerosis and stapedotomy have some effects on the vestibular system, but there are very limited data on their effects on semicircular canals (SCCs).
BACKGROUND
Otosclerosis and stapedotomy have some effects on the vestibular system, but there are very limited data on their effects on semicircular canals (SCCs).
OBJECTIVE
The aim of the study is to investigate if otosclerosis and stapedotomy have an effect on SCCs and video head impulse test (vHIT).
MATERIAL AND METHODS
This retrospective study included 11 otosclerosis patients who had undergone stapedotomy and 30 healthy participants. Twenty-two ears of 11 patients with otosclerosis were divided into two groups based on whether the ear had been operated (12 ears) or not (10 ears). All participants underwent vHIT. We compared gains of all SCCs, presence of saccades among the operated ears, unoperated ears and control ears.
RESULTS
Significant difference (<.05) was noted in comparisons of gain of lateral SCCs among all groups. Control group had the highest gain, followed by unoperated and operated groups, respectively. Comparison of incidence of covert saccade showed significant difference (<.05) for lateral and posterior SCCs.
CONCLUSIONS AND SIGNIFICANCE
Otosclerosis and otosclerosis surgery may have some effects on SCC functions and thereby vHIT. Lateral SCC is the most affected SCC in terms of gain. These findings appear to add important contributions to our knowledge.
Topics: Adult; Analysis of Variance; Case-Control Studies; Female; Head Impulse Test; Humans; Male; Middle Aged; Otosclerosis; Retrospective Studies; Semicircular Canals; Stapes Surgery
PubMed: 33522866
DOI: 10.1080/00016489.2021.1873416 -
European Archives of... Nov 2021The purpose of the study was to know whether the wideband absorbance measurements can be a useful tool to identify ears with otosclerosis. The present study analyzed WBA...
PURPOSE
The purpose of the study was to know whether the wideband absorbance measurements can be a useful tool to identify ears with otosclerosis. The present study analyzed WBA measurements and highlighted its effectiveness in identifying ears with otosclerosis and differentiating from healthy normal ears.
METHODS
The study included 42 ears with otosclerosis which were compared with an equal sample size of healthy normal ears. WBA across frequencies and wideband average absorbance (375-2000 Hz) at the peak and ambient pressure, and resonance frequency were measured and analyzed.
RESULTS
Results showed that WBA levels increased with an increase in frequencies up to 2000 Hz and decreased thereafter, both in the otosclerosis and healthy normal ears. The mean WBA in the otosclerosis group was significantly lower in the 250-2000 Hz frequency range than in the healthy normal ear group. The WBA values at ambient pressure reduced significantly up to 500 Hz for the healthy normal ear group and 1500 Hz for otosclerosis group, compared with peak pressure. Further, the analysis of wideband average absorbance at ambient pressure showed reduced absorbance (0.35) and higher resonance frequency (1350.33 Hz) in the otosclerosis group compared with the healthy normal ear group (0.60 and 930.14 Hz, respectively). ROC analysis indicated that WBA is suitable for identifying otosclerotic ears and also in differentiating from healthy normal ears based on WBA values from 250 to 1500 Hz. High diagnostic values of WBA (> 90% sensitivity and specificity) were observed at a frequency of 1000 Hz.
CONCLUSIONS
The inclusion of WBA into clinical routine test procedures could be a useful tool for detecting otosclerosis. Further research is required to validate its clinical use in combination with other middle ear measures.
Topics: Acoustic Impedance Tests; Ear; Ear, Middle; Humans; Otosclerosis; Sensitivity and Specificity
PubMed: 33388979
DOI: 10.1007/s00405-020-06571-x -
Auris, Nasus, Larynx Aug 2014To compare and evaluate the hearing outcome and complications of otosclerosis treated with the laser or non-laser stapedotomy using meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To compare and evaluate the hearing outcome and complications of otosclerosis treated with the laser or non-laser stapedotomy using meta-analysis.
METHODS
A thorough search for publications and "in-process" articles with English abstract dating from January 1978 to July 2013 was conducted using Pubmed, EBSCO and Web of Science databases, as well as all related papers. The included criteria were otosclerosis as diagnosis, clear description of surgical methods, calibrated stapedotomy and regular collection of functional results. Hearing results and other comparable data (age, preoperative hearing status, and mean length of follow-up) were collected from the articles.
RESULTS
Eleven studies with a total of 1614 subjects were identified to meet our criteria. There was a significant difference in the efficacy of stapedotomy with the laser or non-laser technique; current data showed a combined RR of 1.07 (95% CI: 1.02-1.13, p=0.005). But, the postoperative complication showed no advantage for the laser group, with a combined RR of 0.63 (95% CI: 0.30-1.34, p=0.23). Although there was publication bias in this study (p=0.005), the funnel plot would turn out to be symmetrical after six more studies were added by the trim and fill method.
CONCLUSION
Our overall results suggest that the laser stapedotomy had significantly better hearing results than non-laser stapedotomy. However, current papers on laser and non-laser stapedotomy did not provide enough subjects to make a subgroup analysis of the hearing outcome between different laser groups. More studies reporting different laser techniques are required to provide us with a better understanding of laser stapedotomy.
Topics: Adult; Evaluation Studies as Topic; Follow-Up Studies; Hearing; Humans; Laser Therapy; Odds Ratio; Otosclerosis; Postoperative Complications; Stapes Surgery; Treatment Outcome
PubMed: 24572322
DOI: 10.1016/j.anl.2013.12.014 -
Otology & Neurotology : Official... Dec 2015The aim of this study is to determine if the cumulative summation test for the learning curve (LC-CUSUM) and the cumulative summation graph (CUSUM) can be used to... (Review)
Review
OBJECTIVE
The aim of this study is to determine if the cumulative summation test for the learning curve (LC-CUSUM) and the cumulative summation graph (CUSUM) can be used to demonstrate landmark points of competence and maintenance of proficiency in stapes surgery over a continuous time period.
STUDY DESIGN
Retrospective review from January 1999 until August 2014.
SETTING
Tertiary referral hospital.
PATIENTS
All adult patients with confirmed otosclerosis.
INTERVENTION(S)
Two-hundred and four primary and revision stapedotomy.
MAIN OUTCOME MEASURE(S)
Learning curves were constructed using the CUSUM and LC-CUSUM. Failure was defined as closure of the ABG >10 dB in less than 10% of patients to demonstrate the landmark point of competency and to highlight any fluctuations over a prolonged period.
RESULTS
When the failure rate was defined as closure of the ABG >10 dB, it was not possible to create useful LC-CUSUM and CUSUM graphs, but by redefining the failure rate as > 15 dB, competency was reached at case 43 and maintained with natural fluctuations occurring between cases 137 and 149 and again at case 196.
CONCLUSIONS
LC-CUSUM and CUSUM are a more robust analytical method of illustrating the learning curve and suggest that the traditional benchmark of closure of the ABG ≤10 dB in more than 90% of patients may need reconsideration. It can also be used as standardized audit tools when monitoring results and used to plan future training programs as they clearly define a point when novice trainees become competent.
Topics: Adult; Clinical Competence; Female; Humans; Learning Curve; Male; Middle Aged; Otosclerosis; Reoperation; Retrospective Studies; Stapes Surgery
PubMed: 26496671
DOI: 10.1097/MAO.0000000000000887 -
Neuroimaging Clinics of North America May 2022Various anatomic structures and variants in the temporal bone are potential radiological mimics and surgical hazards. The imaging features of normal variants and lesions... (Review)
Review
Various anatomic structures and variants in the temporal bone are potential radiological mimics and surgical hazards. The imaging features of normal variants and lesions with similar imaging appearance are presented in this article. Throughout the article, salient features that can help elucidate the distinguishing features between mimics and imaging pitfalls are presented.
Topics: Humans; Otosclerosis; Temporal Bone
PubMed: 35526961
DOI: 10.1016/j.nic.2022.01.007 -
The Laryngoscope Jun 2023To evaluate speech outcomes and facial nerve stimulation (FNS) rates in patients with far advanced otosclerosis (FAO) after cochlear implantation. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate speech outcomes and facial nerve stimulation (FNS) rates in patients with far advanced otosclerosis (FAO) after cochlear implantation.
METHODS
A systematic review was performed using standardized methodology of Medline, EMBASE, PubMed, Cochrane, and Web of Science databases. Studies were included if adults with FAO underwent cochlear implantation. Exclusion criteria included concurrent otologic history (e.g., Meniere's disease, superior canal dehiscence), non-English-speaking implant users, case reports, abstracts, and letters/commentaries. Bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the National Institute of Health Scale for case series. The primary outcome measure was speech discrimination and the secondary outcomes were rates of partial insertion and FNS.
RESULTS
Twenty-seven studies evaluated cochlear implantation in FAO. Due to the heterogeneity of testing methods, statistical pooling of speech discrimination was not feasible, but qualitative synthesis indicated a positive effect of implantation. Pooled rates of FNS were 18% (95% confidence interval, CI 12%-27%) and the rate of partial insertion was 10% (95% CI 7%-15%).
CONCLUSION
Cochlear implantation in FAO demonstrates significant gains in speech discrimination scores with higher rates of FNS and partial insertion. Laryngoscope, 133:1288-1296, 2023.
Topics: Adult; Humans; Cochlear Implantation; Otosclerosis; Retrospective Studies; Meniere Disease; Facial Nerve; Cochlear Implants; Speech Perception; Treatment Outcome
PubMed: 36082830
DOI: 10.1002/lary.30386