Interventions for the Diagnosis and Management of Otosclerosis: An Umbrella Review

Perform an umbrella review (a systematic review of systematic reviews) to identify interventions for the prevention, diagnosis, and management of otosclerosis, to inform the development of the World Health Organization (WHO) Package of Ear and Hearing Care Interventions (PEHCI).

PubMed, Scopus, and Ovid MEDLINE databases were searched from January 1, 2014, to February 4, 2025.

Two independent reviewers screened articles and extracted data, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2 tool was used to assess study quality and risk of bias.

Eleven systematic reviews, including 163 studies and 6235 patients, met inclusion criteria. Computed tomography scans demonstrated variable diagnostic performance (60%-95% sensitivity, 75%-100% specificity). Endoscopic and microscopic stapedotomy showed similar air-bone gap closure rates, but endoscopic surgery showed reduced risk of dysgeusia and reduced need for chorda tympani nerve manipulation. Cochlear implantation for advanced otosclerosis generally yielded favorable hearing outcomes. Evidence for medical treatment (eg, sodium fluoride, bisphosphonates) and stapedotomy techniques (eg, laser techniques, crimping, piston diameters) were equivocal in terms of audiological outcomes and superiority of specific techniques.

This review identifies and synthesizes evidence-based interventions for otosclerosis. Treatment options are effective for most otosclerosis patients, but research is required to determine the utility of medications and superiority of specific stapedotomy techniques. These findings will inform the WHO PEHCI, which aims to promote integration of ear and hearing services, including those related to otosclerosis, into national health systems and policies.