Mediterr J Otol 2005:1(2):8-13.

Early audiometric evaluations may predict cochlear damage after stapes surgery

Barbara M., Ronchetti F., Cerruto R. Bandiera G., Monini S., Filipo R.
Dept. of Neurology and Otolaryngology, University of Rome "La Sapienza", Rome, Italy. roberto.filipo@uniroma1.it

OBJECTIVES: We evaluated early and late improvements in postoperative airbone gap in patients following stapes surgery and sought correlations between postoperative cochlear symptoms and early postoperative audiometric test results.

PATIENTS AND METHODS: Clinical and surgical records of 91 patients (29 men, 62 women; mean age 48 years; range 18 to 82 years) with otosclerosis were reviewed following stapedotomy with the small fenestra technique without interposition. The same Teflon-platinum piston was used in all the patients. Audiometric tests were performed within a week before the operation, 5 to 7 days (early evaluation) and at least three months after surgery (late evaluation). The air-bone gap and air conduction thresholds were measured at 4 and 8 kHz. The presence or absence of cochlear symptoms (tinnitus, fullness) were evaluated with the use of a questionnaire preoperatively and in the early and late postoperative periods.

RESULTS: Complete air-bone gap closure or a closure to less than 20 dB were obtained in 65 patients (71.4%) in the early postoperative period, and in 87 patients (95.6%) in the late period (p<0.001). Sensorineural deterioration at 4 kHz was found in 24 patients (26.4%), 21 of whom had an air-bone gap of varying degrees in the early postoperative period. Preoperatively, 66 patients (72.5%) had tinnitus and 30 patients (33.0%) had fullness. Tinnitus disappeared in 26 patients (39.4%, p<0.001) and in eight patients (12.1%, p=0.073), fullness disappeared in eight patients (26.7%, p=0.004) and in nine patients (30%) in the early and late postoperative evaluations, respectively. Newly developed tinnitus and fullness were seen in three patients (3.3%) and in another three patients, respectively. All the patients in whom cochlear symptoms (tinnitus and fullness) disappeared after surgery had either a complete air-bone gap closure or a closure 10 to 20 dB in the early postoperative period, and a complete closure in the late postoperative period. However, none of the patients with newly developed cochlear symptoms exhibited closure in the early postoperative period.

CONCLUSION: Early audiometric evaluations can help identify patients at risk for postoperative cochlear symptoms, such as tinnitus, fullness, and sensorineural hearing loss. For these patients, a careful postoperative follow-up including a longer bed rest after surgery may be beneficial.