Intraoperative Audiometry in Primary Stapes Surgery

Objective: – This study evaluates the feasibility and predictive value of intraoperative pure tone audiometry (PTA) during primary stapes surgery. As a secondary aim, we explored whether preoperative air conduction (AC) thresholds and air-bone gap (ABG) values may influence intraoperative and postoperative hearing outcomes. Study design: – Retrospective case series. Setting: – “Ramazzini” Hospital, Carpi (Modena), Italy. Patients and interventions: – Patients consecutively undergoing primary stapes surgery for otosclerosis between November 2022 and June 2023 were included. All surgeries were performed microscopically under local anesthesia. Main outcome measures: – A correlation analysis was performed between intraoperative and postoperative AC PTA to evaluate the predictive value of intraoperative testing. As a secondary analysis, the potential influence of preoperative hearing status on intraoperative and postoperative outcomes was evaluated by correlating preoperative AC PTA and ABG with AC gain. Predicted AC gain was defined as the difference between intraoperative and preoperative AC PTA, whereas effective AC gain was defined as the difference between postoperative and preoperative AC PTA. Results: – Twenty-eight patients were included. Significant improvements in AC thresholds for single frequencies and PTA were observed both intraoperatively and postoperatively compared with preoperative values. A strong positive correlation emerged between intraoperative and postoperative AC PTA (r = 0.76, P < 0.005), indicating the predictive value of intraoperative testing. Importantly, postoperative AC thresholds improved by an average of 0.73 dB compared with intraoperative measurements. As a secondary finding, preoperative ABG, but not preoperative AC PTA, was observed to have an association with intraoperative and postoperative outcomes. Conclusions: – Intraoperatory AC PTA was shown to predict with a good approximation postoperative audiometric outcomes of primary stapedoplasty and is a simple, rapid, and cost-effective method for immediate functional assessment.