Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis

Area of Science:

• Otolaryngology
• Neurosurgery
• Audiology

Background:

• Advanced otosclerosis presents challenges for hearing restoration.
• Stapedotomy and cochlear implantation are surgical options for hearing loss in otosclerosis.
• Comparing outcomes is crucial for patient management.

Purpose of the Study:

• To compare hearing outcomes of stapedotomy versus cochlear implantation in advanced otosclerosis.
• To evaluate speech recognition scores between the two surgical interventions.
• To assess outcomes of salvage cochlear implantation after failed stapedotomy.

Main Methods:

• Systematic literature search of PubMed, EMBASE, and Cochrane Library up to March 2015.
• Inclusion of studies comparing stapedotomy and cochlear implantation for advanced otosclerosis.
• Analysis of postoperative speech recognition scores using weighted mean difference and 95% confidence intervals.

Main Results:

• Cochlear implantation demonstrated significantly better speech recognition than stapedotomy (P < .0001).
• No significant difference in speech recognition between cochlear implantation and successful stapedotomy with hearing aid (P = .47).
• Similar speech recognition outcomes between primary and salvage cochlear implantation (P = .22).

Conclusions:

• Cochlear implantation provides statistically superior and consistent speech recognition improvement.
• Stapedotomy is effective in approximately half of patients, with results comparable to cochlear implantation.
• Salvage cochlear implantation after stapedotomy failure offers outcomes as favorable as primary implantation.