Tinnitus and hearing outcomes following stapes surgery in otosclerosis patients: A systematic review and meta-analysis

Purpose To evaluate tinnitus and audiological outcomes following stapes surgery in otosclerosis patients with preoperative tinnitus. Methods A literature search of PubMed, EMBASE, and Web of Science was conducted to identify studies published between 1990 and 2026 involving otosclerosis patients with preoperative tinnitus who underwent primary stapes surgery (stapedectomy or stapedotomy). Studies were included if tinnitus outcomes were assessed using Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), or self-reported tinnitus changes. Audiological outcomes were extracted when reported. Cases involving revision procedures were excluded. Random-effects meta-analyses were performed for TFI scores, self-reported tinnitus changes, and audiological outcomes. Results Of 313 articles identified, 19 studies involving 1318 otosclerosis patients with preoperative tinnitus were included. Tinnitus outcomes were evaluated using TFI in five studies, THI in two, and VAS in two. Four studies ( n = 412) were included in the meta-analysis of TFI, which demonstrated a significant postoperative reduction (mean difference: −10.87; 95% CI: −16.04 to −5.69; p < 0.00001). Self-reported tinnitus changes were available from 14 studies ( n = 868), with weighted proportions showing tinnitus disappearance in 48.52% (95% CI: 37.95–59.15%), alleviation in 28.60% (95% CI: 21.51–36.27%), no change in 18.12% (95% CI: 12.23–24.87%), and deterioration in 3.78% (95% CI: 1.71–6.61%). Six studies ( n = 306) were included in the meta-analysis of air-bone gap (ABG) closure outcomes, indicating that 67.17% (95% CI: 40.94–88.64%) and 91.50% (95% CI: 79.10–98.64%) of patients achieved postoperative ABG of ≤10 dB and ≤ 20 dB, respectively. Conclusions Approximately 70–80% of patients reported tinnitus relief following stapes surgery, and pooled TFI scores decreased significantly postoperatively. However, substantial heterogeneity and the lack of non-surgical comparison groups limit causal interpretation. Additionally, the relationship between tinnitus relief and hearing improvement remains uncertain. Further multicenter, prospective studies with appropriate control groups are warranted to clarify prognostic factors.