This paper discusses the management options of advanced otosclerosis. There are several definitions for advanced otosclerosis in the literature but, more recently, the diagnosis of advanced otoscletosis has been reserved for patients who have less than 30% aided speech discrimination score at 70dB.

CT and MRI imaging is advocated for patients with suspected advanced otosclerosis. High resolution CT has a high sensitivity in picking up oval window involvement, while MRI would give more information on the luminal patency of the cochlea, especially if cochlear implantation (CI) is being considered.

The main treatment options for patients with advanced otosclerosis include hearing aids, stapedectomy and hearing aids or CI. The authors stressed the importance of careful patient selection. Benefits of stapedectomy include preservation of natural sound, lower cost and shorter operation. However, it does not treat sensorineural hearing loss and patients would need to wear hearing aids. They also found papers describing patients with severe retrofenestral sclerosis and speech discrimination scores of less than 30% are more likely to have a poor outcome from stapedectomy. CI for advanced otosclerosis has been shown in a meta-analysis to have a better speech perception result when compared with stapedectomy. Complications from CI for advanced otosclerosis patients are similar to any CI patients but they were found to have an increased risk of facial nerve stimulation. CI may be challenging to perform as well, as in some patients, the scala tympani or even the basal turn of the cochlea may be obliterated. The authors conclude that in advanced otosclerosis, patients should be treated with stapedectomy and hearing aids first and only if patients fail to experience benefit, should CI be offered.

Advanced otosclerosis: Stapes surgery or cochlear implantation?
AA Eshraghi, K Ila, E Ocak, FT Telischi.
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Wai Sum Cho

Queens Medical Centre, Nottingham, UK.

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