Otic Capsule Demineralization and Hearing Outcomes After Stapes Surgery for Otosclerosis

Objective: To investigate the correlation between otic capsule demineralization and pre- and postoperative hearing parameters in patients with otosclerosis. Study design: Retrospective study. Setting: University hospital. Patients: A total of 181 ears from152 consecutive patients (39 men; 113 women) with otosclerosis who underwent stapes surgery between January 2003 and December 2020. Interventions: High-resolution computed tomography was used to identify otic capsule demineralization, observed as hypodense areas. Main outcome measures: Preoperative and 12-month postoperative hearing parameters were compared between ears with and without demineralization and further analyzed according to the number of demineralization loci in the affected group. Results: Demineralization was observed in 96 ears (53%), while 85 ears showed no hypodense areas. Preoperative air-conduction (AC) thresholds were significantly worse in the demineralization (+) group due to a larger air-bone gap (ABG), with no significant difference in bone-conduction (BC) thresholds between the groups. Postoperatively, AC remained significantly worse in the demineralization (+) group due to a persistently larger ABG. However, no significant differences were found in postoperative BC thresholds or in the degree of closure of the ABG between groups. The number of demineralization loci (single, double, or triple) was not significantly associated with pre- or postoperative hearing outcomes. Conclusion: Although both pre- and postoperative AC and ABG were worse in the demineralization (+) group, the similar degree of closure of the ABG observed in both groups supports stapes surgery as an effective treatment for otosclerosis, regardless of the presence or extent of otic capsule demineralization.