[Hormone therapy for stapedoplasty in patients with otosclerosis]

Surgical treatment of hearing loss due to otosclerosis is characterized by high clinical efficacy and ensures achievement of an air-bone gap of ≤10 dB in 58-97% of patients. However, acute sensorineural hearing loss as a complication of stapedoplasty occurs in 0.2-0.95% of cases after the primary intervention, in 2.9% after revision stapedoplasty and in 4.8% with the obliterating otosclerosis. Intraoperative adverse factors arising during stapedoplasty play the leading role in the development of early cochleovestibular disorders. On the other hand, the use of glucocorticosteroids (GCS) in the surgical management of patients with otosclerosis remains a subject of debate, as the indications for their use, optimal routes of administration, and clinical efficacy still lack sufficient scientific justification.

To determine the indications for and evaluate the efficacy of hormonal therapy methods in patients undergoing stapedoplasty for otosclerosis.

Between 2020 and 2023, a total of 112 patients with otosclerosis were examined and surgically treated. Among them, 83 were women and 29 were men; the mean age of the patients was 44±10.5 years. The diagnosis was based on data from otomicroscopy, pure-tone audiometry, acoustic impedance audiometry, and computed tomography of the temporal bones, which served to confirm the condition and identify factors that could adversely affect stapedoplasty outcomes. Functional results were assessed using pure-tone audiometry at days 2 and 7, as well as at 3, 6, and 12 months postoperatively. Considering the features of the intraoperative course, the dynamics of air-bone gap closure, and the GCS therapy regimen applied, the patients were divided into three groups. Group 1 consisted of 45 patients who did not receive GCS therapy. Group 2 included 54 patients, subdivided into 2 subgroups: 22 subjects (Group 2a) received topical GCS therapy using bioabsorbable collagen sponges impregnated with the drug and inserted into the round window niche, and 32 subjects (Group 2b) received systemic GCS therapy. The latter was administered due to an adverse intraoperative course to prevent postoperative complications. Group 3 consisted of 13 patients in whom GCS were used both topically and systemically due to adverse intraoperative factors during stapedoplasty and a subsequent increase in bone conduction thresholds detected on day 2 after surgical treatment.

The key factors determining the need for GCS therapy were intraoperative features of the stapedoplasty procedure. In particular, intense tissue bleeding and a pronounced vestibular reaction during vestibulotomy (p≤0.001), as well as blood entering the vestibule and the "dry" vestibule phenomenon (p≤0.05), were significant. In addition, the development of cochleovestibular disorders in the postoperative period is associated not with individual factors, but with their combination. An analysis of the efficacy of topical and systemic dexamethasone in the early stages after stapedoplasty was done based on bone conduction threshold dynamics. In contrast to Group 2b, patients in Groups 1 and 2a showed no clinically significant increase in bone conduction thresholds or signs of cochleovestibular disorders. The results obtained in patients of Group 2a may be attributed to prolonged topical GCS exposure during the intraoperative period when using the developed technique. Despite the higher frequency of combined intraoperative complications in patients of Group 3, bone conduction thresholds remained stable in the postoperative period, which is associated with the use of combination GCS therapy.

In patients with otosclerosis, glucocorticosteroid therapy is indicated for managing adverse intraoperative factors and elevated bone conduction thresholds after stapedoplasty. In cases of intraoperative adverse factors in the absence of cochleovestibular disorders in the postoperative period, the use of topical glucocorticosteroid therapy by placing a hemostatic sponge soaked in dexamethasone solution into the round window niche using the original technique is sufficient to achieve satisfactory functional outcomes. Combined topical and systemic glucocorticosteroid therapy is advisable for treating postoperative cochleovestibular disorders and preventing further progression of hearing loss.