Reporting operative hearing results: does choice of outcome measure make a difference?

Choice of outcome measure in reporting hearing results following otologic surgery, including the frequencies used and use of pre- or postoperative bone thresholds, varies from author to author. In this study, data from 550 ossicular reconstruction and pediatric tympanoplasty surgery patients were used to generate a variety of outcome measures, including pure-tone thresholds for frequencies from 0.5 kHz to 8 kHz and different frequency combination pure-tone averages (PTAs) and air-bone gaps. There were no significant differences between mean pre- and postoperative bone conduction thresholds for any of the frequencies from 0.5 to 4 kHz nor for a PTA of 1, 2, and 4 kHz. Mean postoperative air-bone gap differed by no more than 2 dB across six different frequency combination PTAs. If "success" is defined as a postoperative air-bone gap of less than 20 dB, the largest difference in success rate across the six frequency combinations was 5%. There was also little difference in mean postoperative air conduction PTAs for any of the combinations that include frequencies through 4 kHz. Choice of a more conservative or more liberal definition of success was more important than whether air-bone gap or air conduction PTA was used. The authors recommend that a standard reporting procedure be adopted that ensures presentation of the results in a format such that more direct comparisons can be made within the published literature.