Conventional Reporting Standards Conceal High-Frequency Hearing Deficits After Favorable Ossiculoplasty

Area of Science:

• Otolaryngology
• Audiology
• Biomedical Engineering

Background:

• Ossiculoplasty aims to restore hearing by reconstructing the middle ear ossicular chain.
• Current success metrics for ossiculoplasty often rely on pure-tone average (PTA) air-bone gap (ABG) at lower frequencies.

Purpose of the Study:

• To evaluate high-frequency hearing outcomes in ossiculoplasty patients who met current success criteria based on PTA-ABG.
• To determine if current reporting standards adequately reflect overall hearing improvement after ossiculoplasty.

Main Methods:

• Retrospective cohort study of 499 ossiculoplasty cases with synthetic prostheses from a multi-center registry.
• Included patients had a postoperative PTA-ABG ≤15 dB at 0.5, 1, 2, and 3 kHz.
• Analyzed postoperative 4-kHz ABG and frequency-specific air-conduction threshold changes.

Main Results:

• Mean postoperative PTA-ABG was 9.6 dB, meeting success criteria.
• However, the mean 4-kHz ABG was significantly larger at 18.2 dB (P < .001).
• Over 50% of ears had a 4-kHz ABG ≥20 dB, and air-conduction gains decreased at higher frequencies (4-8 kHz).

Conclusions:

• Standard PTA-based reporting may mask persistent high-frequency conductive hearing loss after ossiculoplasty.
• Current ossiculoplasty success criteria may not fully represent functional hearing outcomes.
• Consideration of ≥4-kHz outcomes is recommended for future hearing outcome reporting standards in conductive hearing loss.