Indication for Surgery in Otosclerotic Patients With Unilateral Hearing Loss

Objective: The aim of this study is to evaluate postoperative spatial speech discrimination in noise in a group of otosclerotic patients with unilateral hearing loss in a 6-month follow-up. Moreover, an additional objective is to verify if our routine criteria (air-bone gap >30 dB at 250-2,000 Hz) for surgical indication in such patients can be acceptable. Study Design: Prospective evaluation in 20 patients divided into 2 groups: unilateral otosclerosis and bilateral otosclerosis already successfully operated on 1 side and planned for stape-dotomy on the contralateral ear. Setting: Tertiary referral center, University clinic. Patients: Otosclerotic patients with unilateral hearing loss. Intervention: Evaluation of functional outcome. Main Outcome Measure: Spatial test based on speech discrimination in noise. Results: All patients reach postoperative air- bone gap closure within 10 dB. Average postoperative gain in discrimination under noise was 11.5% for unilateral otosclerosis group and 19.3% for the second ear group. Conclusion: Free-field discrimination in noise closely reflects the usual listening conditions in everyday life. Improvement in postoperative free-field discrimination in noise can justify our routine criteria for surgical indication in the patients with unilateral otosclerosis and with bilateral otosclerosis already operated on 1 side. The surgical choice for each patient, apart from audiologic evaluation, is linked to a truly informed consent regarding possible advantages and risks mainly based on an analysis of the real auditory needs of the patient and individual results of the surgeon.