Management Options and Their outcomes in Bilateral Advanced Otosclerosis

BACKGROUND: Otosclerosis is a hereditary disorder that causes progressive hearing loss in the adult population. Owing to its progressive nature, a multimodal treatment approach is often required. Management options were offered to patients following comprehensive audiological and radiological evaluation, incorporating the Merkus algorithm in clinical decision-making. This study aims to compare the audiological and speech-related outcomes of cochlear implantation (CI) and stapedotomy with hearing aid use in patients with bilateral advanced otosclerosis. METHODS: This cohort study included 38 patients divided into 2 groups: Group A consisted of patients who underwent CI (n=15), and Group B comprised patients who underwent stapedotomy followed by hearing aid use (n=23). Outcomes were compared using paired t-tests both within and between the groups. RESULTS: Both groups demonstrated significant improvement in hearing and speech outcomes post-intervention. Speech-related outcomes were superior in Group A (cochlear implant recipients) with a statistically significant P value (<.005), whereas hearing-related outcomes were comparable between the 2 groups. Vertigo and tinnitus symptoms showed greater improvement in Group A compared to the Group B cohort. CONCLUSION: In cases of progressive hearing loss, early and appropriate intervention is crucial to preserve residual hearing. Cochlear implantation is effective in improving both audiological and speech outcomes, and it also alleviates symptoms such as tinnitus and vertigo. Conversely, stapedotomy combined with hearing aid use remains a cost-effective management option, providing comparable audiological outcomes.