Stapedotomy Versus Hearing Aids in the Management of Conductive Hearing Loss Caused by Otosclerosis: A Prospective Comparative Study

Objective To compare the outcomes of patients with unilateral otosclerosis treated consecutively by a hearing aid then stapedotomy. Study Design Monocentric, nonrandomized, prospective, longitudinal, cohort study. Setting Tertiary university hospital. Patients Adult patients with a unilateral conductive hearing loss of at least 30 dB caused by otosclerosis. Interventions Consecutive treatment by an external hearing aid followed by stapedotomy. Main Outcome Measures Differences between hearing aids and stapedotomy in quality of life, pure-tone audiometry, binaural hearing, tinnitus severity, and patient satisfaction. Results Twenty-two patients were included, of which 20 (91%) underwent stapedotomy. Stapedotomy demonstrated increased quality of life according to Glasgow Health Status Inventory scores versus hearing aids (+10.4 +/- 9.4 [p = 0.0001]). Stapedotomy versus hearing aids showed improved pure-tone averages (-11.1 +/- 11.0 dB [p = 0.002]) and air-bone gaps (-11.8 +/- 10.7 dB [p = 0.0006]). Stapedotomy was superior to hearing aids for speech-in-noise recognition in the reverse dichotic condition (-8.4 +/- 26.9 dB [p = 0.004]) and showed improved sound localization accuracy in root mean square error (-14.5 +/- 24.5 degrees [p = 0.02]). Stapedotomy, but not hearing aids, showed improved patient self-evaluated tinnitus after baseline adjustment according to the Tinnitus Handicap Inventory (-8.0 +/- 13.4 [p = 0.02]) and visual analog scale for tinnitus intensity (-28.7 +/- 34.1 [p = 0.006]). Overall, patients were more satisfied with surgery versus hearing aids. Conclusions Stapedotomy remains more effective compared with hearing aids with greater improvements in quality of life, patient satisfaction, hearing outcomes, and self-evaluated tinnitus.