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Updated: Jun 20, 2026

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Round Window Drill-Out in Advanced Otosclerosis.

Kaitlyn E Aragon1, Jeffrey T Vrabec2

  • 1Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|June 19, 2026
PubMed
Summary
This summary is machine-generated.

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Round window drill-out (RWD) can help patients with severe hearing loss from otosclerosis. This surgical technique may improve hearing aid effectiveness, offering an alternative to cochlear implants.

Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Audiology

Background:

  • Otosclerosis can cause mixed hearing loss, sometimes with round window obliteration.
  • Advanced otosclerosis may necessitate alternative surgical interventions for hearing restoration.

Purpose of the Study:

  • To evaluate the effectiveness of round window drill-out (RWD) in patients with otosclerosis and round window obliteration.
  • To assess RWD as a potential alternative to cochlear implantation for severe hearing loss.

Main Methods:

  • A retrospective review of 5 ears in 4 adult patients with mixed hearing loss and otosclerosis-induced round window obliteration.
  • Round window drill-out (RWD) was performed, opening the cochlea's basal turn and reconstructing with fascia.
  • Outcomes measured included feasibility, changes in air conduction thresholds, and air-bone gap (PTA-ABG).
Keywords:
Advanced otosclerosisMixed hearing lossRound window drillingRound window obliterationRound window opening

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Main Results:

  • RWD was performed as primary stapedectomy (3 ears), delayed procedure (1 ear), or standalone surgery (1 ear).
  • Median preoperative PTA-ABG was 31.3 dB.
  • Significant PTA-ABG improvement (30-45 dB) was observed in 2 ears; minor improvement in 2 ears; and worsening in 1 ear.

Conclusions:

  • Formal round window drill-out (RWD) may benefit patients with severe mixed hearing loss due to advanced otosclerosis.
  • RWD can facilitate hearing aid use, presenting a viable alternative to cochlear implantation in select cases.