Frequency -Specific Air- Conduction and Bone - Conduction Outcomes after Stapedotomy

Document Type : Original


1 Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Audiology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.


The aim of this study was to investigate hearing outcome of stapes surgery, considering the post-operative air and bone conduction (AC&BC) changes, in a frequency specific approach.
Materials and Methods:
This was a retrospective cohort study. A total of 245 ears (231 patients), who underwent Stapedotomy at our tertiary referral center in a period of 5 years were enrolled in the study. Pure tone audiometry (PTA) was evaluated preoperatively and one month postoperatively. AC, BC, and Air-bone gap (ABG) were documented. Moreover, one-year post-op PTA was also recorded for more than a quarter of the cases.
Overall, significant improvements were observed in AC thresholds with a mean AC gain of 20.44±13.64 dB. At higher frequencies the results were poorer (AC gain of 27 dB at 250 Hz vs 7 dB at 8000 Hz). ABG significantly improved at all frequencies after one month. BC thresholds were typically better after surgery. However, there appears to be a worsening trend in BC thresholds at frequencies higher than 2000 Hz. In 68 patients with 1-year follow-up, BC thresholds were slightly worse (but not statistically significant) at most frequencies, in comparison to the one-month results.
Stapes surgery significantly improves air and bone conduction hearing, particularly at lower frequencies. Nonetheless, there exists a potential for sensorineural hearing loss (SNHL) at high frequencies. However, the changes are insignificant and not within the speech frequencies. Therefore, patients are typically satisfied with the hearing outcome of the surgery.


Main Subjects

  1. House JW, Cunningham CDIII. Otosclerosis. In: Flint PW, Francis HW, editors. Cummings otolaryngology head and neck surgery. 7th ed. Mosby: Philadelphia; 2020. p.2197-8.
  2. Minni A, Sementilli G, Cialente F, Rossetti V, Marinelli A, Ralli M, De Seta D. (2021) Stapedotomy for fenestral otosclerosis: long term audiovestibular outcomes and complications. Hearing, Balance and Communication. [Internet] 2021 [Published online: 27 Jun 2021]. Available from:  DOI: 1080/ 21695717.2021.1943781.
  3. Moscillo L, Imperiali M, Carra P, Catapano F, Motta G. Bone conduction variation poststapedotomy. Am J Otolaryngol. 2006 Sep-Oct; 27(5):330-3. DOI: 10.1016/j.amjoto.2006.03.002
  4. Nazarian R, McElveen JT Jr, Eshraghi AA. History of Otosclerosis and Stapes Surgery. Otolaryngol Clin North Am. 2018 Apr;51(2):275-290. DOI: 1016/j.otc.2017.11.003
  5. Rajati M, Poursadegh M, Bakhshaee M, Abbasi A, Shahabi A. Outcome of stapes surgery for tinnitus recovery in otosclerosis. Int Tinnitus J. 2012;17(1):42-6. PMID: 23906826.
  6. Karimi Yazdi A, Sazgar AA, Motiee M, Ashtiani MK. Improvement of bone conduction after stapes surgery in otosclerosis patients with mixed hearing loss depending from surgical technique. Eur Arch Otorhinolaryngol. 2009 Aug;266(8):1225-8. DOI: 10.1007/s00405-009-0918-7
  7. Quaranta N, Besozzi G, Fallacara RA, Quaranta A. Air and bone conduction change after stapedotomy and partial stapedectomy for otosclerosis. Otolaryngol Head Neck Surg. 2005 Jul;133(1):116-20. DOI: 10.1016/j.otohns.2005.03.011
  8. Aarnisalo AA, Vasama JP, Hopsu E, Ramsay H. Long-term hearing results after stapes surgery: a 20-year follow-up. Otol Neurotol. 2003 Jul;24(4):567-71. DOI: 10.1097/00129492-200307000-00006
  9. Garcia-Iza L, Navarro JJ, Goiburu M, Pérez N, Altuna X. Study of the improvement in bone conduction threshold after stapedectomy. Acta Otorrinolaringol Esp. 2016 Sep-Oct;67(5):268-74. DOI: 1016/j.otorri.2015.11.003
  10. Schönfeld U, Weiming H, Hofmann VM, Jovanovic S, Albers AE. CO2laser stapedotomy safety: influence of laser energy and time on bone-conduction hearing levels. Eur Arch Otorhinolaryngol. 2017 Dec; 274(12): 4131-4139. DOI: 10.1007/ s00405-017-4769-3
  11. Vincent R, Sperling NM, Oates J, Jindal M. Surgical findings and long-term hearing results in 3,050 stapedotomies for primary otosclerosis: a prospective study with the otology-neurotology database. Otol Neurotol. 2006 Dec;27(8 Suppl 2): S25-47. DOI: 10.1097/01.mao. 0000235311. 80066.df
  12. Strömbäck K, Köbler S, Rask-Andersen H. High frequency hearing following stapes surgery. Acta Otolaryngol. 2012 Sep;132(9):944-50. DOI:  3109/00016489.2012.677859
  13. Bauchet St Martin M, Rubinstein EN, Hirsch BE. High-frequency sensorineural hearing loss after stapedectomy. Otol Neurotol. 2008 Jun;29(4):447-52. DOI: 1097/MAO.0b013e318172d6a3
  14. Lucidi D, Paludetti G, Settimi S, De Corso E, Picciotti P, M, Sergi B: How Long Is Otosclerosis Surgery Effective? Hearing Results after a 22-Year Follow-Up. Audiol Neurotol. 2021;26:121-126. DOI: 1159/000509106
  15. Just T, Guder E, Pau HW. Effect of the stapedotomy technique on early post-operative hearing results--Preliminary results. Auris Nasus Larynx. 2012 Aug;39(4):383-6. DOI: 1016/j. anl.2011.07.009
  16. Committee on Hearing and Equilibrium: Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg. 1995;113: 186–7. DOI: 1016/S0194-5998(95)70103-6
  17. Bagger-Sjöbäck D, Strömbäck K, Hultcrantz M, Papatziamos G, Smeds H, Danckwardt-Lillieström N, Tideholm B, Johansson A, Hellström S, Hakizimana P, Fridberger A. High-frequency hearing, tinnitus, and patient satisfaction with stapedotomy: A randomized prospective study. Sci Rep. 2015 Aug 21;5:13341. DOI: 10.1038/srep13341
  18. Lamblin E, Karkas A, Jund J, Schmerber Is the Carhart notch a predictive factor of hearing results after stapedectomy?. Acta Otorhinolaryngol Ital. 2021 Feb; 41(1): 84–90. DOI: 10.14639/0392-100X-N0213
  19. Perez R, de Almeida J, Nedzelski JM, Chen JM. Variations in the "Carhart notch" and overclosure after laser-assisted stapedotomy in otosclerosis. Otol Neurotol. 2009 Dec;30(8):1033-6. DOI:  1097/ MAO.0b013e31818edf00


  1. Sabbe A, Verhaert N, Joossen I, Lammens A, Debruyne F. Otosclerosis: Shift in bone conduction after stapedotomy. B-ENT. 2015;11(3):183-9. PMID: 26601550
  2. McClenaghan F, Lavy J. Does bilateral otosclerosis make pre-operative bone conduction more inaccurate?. J Otology. 2021 Jan;16(1):1-5. DOI: 1016/j.joto.2020.07.002
  3. Manuele C, Francesco C, Massimiliano V, Antonio M, Paol V, et al.. Bone Conduction after Stapes Surgery in Otosclerotic Patients with Mixed Hearing Loss: Fact or Fiction?. Inter J Otorhinolaryngology. 2015;2(2):4.
  4. Souza JC, Bento RF, Pereira LV, et al. Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution. Int Arch Otorhinolaryngol. 2016; 20(1): 39-42. DOI: 10.1055/s-0035-1563540
  5. Sharaf K, Grueninger I, Hilpert A, Polterauer D, Volgger V, Manz K, Canis M, Hempel JM, Müller J. Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker. Otol Neurotol. 2021 Aug; 42(7):985-93. DOI:  1097/MAO. 0000000000003145
  6. Shah V, Ganapathy H. Factors Affecting the Outcome of Stapes Surgery. Indian J Otolaryngol Head Neck Surg. 2018 Jun;70(2):256-261.  DOI: 1007/s12070-017-1134-1
  7. FaraneshN, Magamseh E,  Zaaroura S, Zeidan R, Shupak Hearing and Otoacoustic Emissions Outcome of Stapedotomy: Does the Prosthesis Diameter Matter?. J Int Adv Otol. 2017 Aug;13(2):162-170. DOI: 10.5152/iao.2017.3378
  8. Sim JH, Chatzimichalis M, Lauxmann M, Röösli C, Eiber A, Huber AM. Complex Stapes Motions in Human Ears. J Assoc Res Otolaryngol. 2010 Sep; 11(3): 329–341. DOI: 10.1007/s10162-010-0207-6.