Stapes hypermobility as a possible cause of hyperacusis.

Area of Science:

• Otolaryngology
• Neurosurgery
• Audiology

Background:

• Hyperacusis, a condition of reduced sound tolerance, often lacks a clear etiology.
• Previous studies suggest minimally invasive surgical procedures can alleviate hyperacusis symptoms.

Purpose of the Study:

• To investigate the efficacy of oval and round window reinforcement, with additional stapes superstructure reinforcement for suspected hypermobile stapes, in patients with severe hyperacusis.
• To explore the potential mechanical basis of hyperacusis related to stapes mobility.

Main Methods:

• A prospective, single-arm study involving 21 patients with severe hyperacusis undergoing oval and round window reinforcement.
• Seven patients with intraoperatively identified stapes hypermobility received additional stapes superstructure reinforcement.
• Outcomes were assessed using loudness discomfort levels (LDL), Hyperacusis Questionnaire (HQ) scores, and Numeric Rating Scale (NRS) for pain.

Main Results:

• Cohort A (window reinforcement) showed significant improvements: LDL increased from 72.7 to 81.9 dB, HQ scores decreased from 30.1 to 14.7, and NRS scores dropped from 8.5 to 4.0.
• Cohort B (additional stapes reinforcement) demonstrated even greater improvements: LDL rose from 72.4 to 88.2 dB, HQ scores fell from 35.8 to 18.9, and NRS scores decreased from 10.0 to 3.7.
• 76% of patients reported improved quality of life and reduced hyperacusis symptoms post-surgery, with no hearing loss complications.

Conclusions:

• Stapes hypermobility may be a mechanical cause for hyperacusis in some patients.
• Minimally invasive surgical reinforcement of the stapes and windows is a promising treatment for hyperacusis.
• Further research is needed to fully elucidate the role of stapes mobility in hyperacusis.