Treatment Options for Stapes-Related Disorders
Primary Treatment: Stapedotomy/Stapedectomy for Otosclerosis
For patients with otosclerosis affecting the stapes, surgical intervention with stapedotomy or stapedectomy is the definitive treatment that achieves significant hearing improvement and should be offered to restore auditory function. 1, 2
Surgical Outcomes and Effectiveness
Stapedotomy achieves air-bone gap closure to less than 20 dB in 70-72% of patients and less than 30 dB in 90% of patients at 6 months postoperatively, with hearing improvements lasting many years 2, 3
Both stapedotomy and stapedectomy demonstrate statistically significant improvement in air conduction thresholds at 125,250,500,1000,2000, and 4000 Hz, with bone conduction also improving significantly at 500 and 1000 Hz due to restored ossicular chain resonance 1
Mean air-bone gap improves from approximately 39 dB preoperatively to 11 dB postoperatively, with speech reception thresholds improving from 56.25 to 24.27 (p<0.05) 2
Surgical treatment for stapes fixation is safe, with no patients experiencing profound hearing loss after surgery and complication rates comparable to other chronic ear surgeries 3
Surgical Indications and Timing
Surgery should be considered even for patients with air-bone gaps smaller than the traditional 20 dB threshold, as early intervention can arrest disease progression, preserve inner ear structures, and provide complete auditory recovery 4
Delaying surgery in otosclerosis risks progression to high-degree hearing loss, particularly in patients with inner ear involvement who may also experience tinnitus and vestibular disorders 4
Diagnostic Imaging
CT temporal bone without contrast is the first-line imaging modality for evaluating conductive hearing loss related to stapes pathology, providing excellent delineation of the ossicular chain and identifying otospongiosis (otosclerosis), ossicular erosion or fusion, and other bony abnormalities 5
Intravenous contrast is not beneficial for temporal bone evaluation in conductive hearing loss due to the density of surrounding bone and small size of ossicular structures 5
MRI is insufficient for delineating bony details needed for stapes evaluation and should not be used as first-line imaging 5
Conservative Medical Management
Medical therapy with sodium fluoride or bisphosphonates may be considered for patients who decline surgery or have contraindications, though surgical outcomes remain superior for hearing restoration 6
Sodium Fluoride Protocol
- Sodium fluoride administered for at least 6 months stabilizes hearing thresholds, improves vestibular symptoms, and delays tinnitus worsening by slowing the bone resorption phase of otospongiosis 6
Bisphosphonate Therapy
- Bisphosphonates given for at least 6 months show significant improvement in hearing loss, dizziness, and tinnitus remission, with 24-month treatment courses demonstrating greater stabilization of air and bone conduction thresholds compared to placebo 6
Important caveat: Medical therapy aims to stabilize rather than reverse hearing loss, whereas surgery provides actual hearing restoration 6
Alternative Surgical Options for Tympanosclerosis
When tympanosclerosis involves the stapes, both mobilization procedures and stapedectomy achieve significant hearing improvement (p<0.05) with no statistically significant differences in outcomes between techniques at 6 months, 2 years, and 5 years 3
Hearing Rehabilitation for Unilateral Cases
For patients with single-sided deafness from stapes pathology who cannot undergo or fail surgical treatment, osseointegrated bone conductive devices (BAHA) effectively transmit sound from the affected side to the better-hearing cochlea, achieving significant improvement in hearing handicap scores and quality of life 7
- BAHA achieves air-bone gap closure in 85% of cases with mixed hearing loss and addresses the substantial communication difficulties experienced by 86% of adults with unilateral hearing loss 7