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Background
Stapedotomy or stapedectomy is commonly performed to treat conductive (CHL) or mixed hearing loss (MHL), most often due to otosclerosis. Pneumatic otoscopy, tuning fork tests, diagnostic audiometry, and acoustic reflex testing are widely accepted to be sufficient for preoperative assessment. High-resolution computed tomography (CT) may reveal hypodense foci or bone deposition within the oval window and otic capsule. CT may also reveal other causes of the hearing loss. Use of preoperative CT varies widely. Some surgeons routinely obtain preoperative CT, whereas others reserve this for atypical presentations or when considering revision surgery. Preoperative CT incurs added cost and radiation exposure. Though there are a number of potential roles of CT prior to stapedotomy, the relative indications are poorly defined in the literature.
Best Practice
Literature review does not support routine use of CT prior to planned primary stapedotomy in patients with adult-onset CHL/MHL, and clinical findings consistent with otosclerosis. Factors influencing the decision to obtain preoperative CT are summarized in Table 1. Selective use of CT is recommended, and symptoms accompanying progressive hearing loss (i.e., atypical cases), patient age, age of hearing loss onset, and a family history of early-onset hearing loss should all be considered.
Table 1: Factors Influencing the Decision to Obtain Preoperative Computed Tomography Prior to Planned Stapedotomy.
| Defer Preoperative Imaging | Consider Preoperative Imaging | Favor Preoperative Imaging |
|---|---|---|
| Adult-onset hearing loss | Adolescent-onset hearing loss | Childhood-onset hearing loss |
| Bilateral conductive hearing loss | Unilateral conductive or mixed hearing loss | Intact stapedial reflex Autophony |
| Progressive hearing loss | Unknown time course of hearing loss | Vertiginous complaints |
| Absent stapedial reflex | Abnormal stapedial reflex | Family history of childhood- onset hearing loss |
| Nonpulsatile tinnitus | Pulse synchronous tinnitus | Abnormal otoscopy* |
| No vestibular complaints | Nonvertiginous balance complaints | |
| Family history of surgically confirmed otosclerosis | Family history not known | |
| Normal otoscopy | ||
| Progressive hearing loss | ||
| *Excluding Schwartze sign. |