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Stapedotomy vs Stapedectomy: Hearing Outcomes & Dizziness

Publication Title: Effects of stapes surgery prosthesis type on hearing outcome, post-operative dizziness and benzodiazepine use

Summary

Question
This study investigated the impact of surgical method and prosthesis type on hearing outcomes, post-operative dizziness, and benzodiazepine use in patients undergoing stapes surgery for otosclerosis. The researchers aimed to compare stapedotomy, which uses a McGee piston prosthesis, and stapedectomy, which employs a ribbon loop prosthesis, to identify differences in clinical outcomes.
Why it Matters
Otosclerosis is a common cause of hearing loss in adults, accounting for over 20% of conductive hearing loss cases. Surgical treatments, such as stapedotomy and stapedectomy, aim to restore hearing but may result in complications like dizziness. Understanding how prosthesis type influences hearing improvement and post-operative side effects can guide surgeons in optimizing patient care and reducing reliance on medications like benzodiazepines, which carry risks of addiction and side effects. This research provides valuable insights into surgical decision-making and patient counseling.
Methods
The researchers conducted a retrospective review of medical records from 276 stapes surgeries performed between 2013 and 2022. Patients aged 18 or older with otosclerosis were included. The study compared outcomes between 132 stapedotomies using McGee pistons and 144 stapedectomies using ribbon loops. Key variables assessed included hearing improvement, post-operative dizziness, and medication use. Audiograms were performed pre-operatively and three months post-operatively to measure changes in hearing thresholds.
Key Findings
Both surgical approaches achieved similar improvements in air–bone gap (ABG) closure, a measure of hearing improvement. However, stapedectomy patients showed a greater improvement in speech reception thresholds (SRT), which reflect the ability to understand spoken words. Dizziness occurred at low rates in both groups (3.8% for stapedotomy, 7.6% for stapedectomy), but benzodiazepines, specifically diazepam, were prescribed more frequently for stapedectomy patients experiencing dizziness. No long-term dizziness or need for ongoing medication was observed in either group.
Implications
The findings confirm that both stapedotomy and stapedectomy are effective and safe surgical options for treating otosclerosis. While stapedectomy may offer slightly better speech recognition improvement, it is associated with a higher likelihood of benzodiazepine use for managing dizziness. Surgeons can use this information to better counsel patients on expected outcomes and potential side effects, balancing hearing benefits with post-operative comfort and medication risks.
Next Steps
The researchers recommend further studies, particularly multi-institutional prospective trials, to explore the long-term outcomes of stapes surgeries and refine comparisons between prosthesis types. Future research could also focus on reducing post-operative dizziness and minimizing the need for benzodiazepines.
Funding Information
The authors declared that no funding was used for this research project. Yale University also provided funding and support for this research.

Full Citation

Wilkins S, Shah R, Valdez C, Malik D, Tyagi S, Hildrew D, Schwartz N. Effects of stapes surgery prosthesis type on hearing outcome, post-operative dizziness and benzodiazepine use. The Journal Of Laryngology And Otology 2025, 139: 1196-1201. PMID: 41030100, PMCID: PMC12674984, DOI: 10.1017/s0022215125103575.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.

Authors

  • Sarah G. Wilkins

    First Author
    School Building Streamline Icon: https://streamlinehq.comOther Institution

  • Nofrat Schwartz, MD

    Last Author
    Yale School of Medicine

    Assistant Professor of Surgery (Otolaryngology)

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Additional Yale School of Medicine Authors

Other Authors

  • Rema Shah;
  • Caroline Valdez;
  • Devesh Malik

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