A new treatment algorithm for advanced otosclerosis, based on the clinical experience of Dutch investigators and supported by a literature review they conducted, suggests that the window for successful cochlear implantation (CI) in patients with severe disease is narrower than some otolaryngologists may believe (Laryngoscope. 2011;121(9):1935-1941).
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January 2012According to the authors, once ossification of the middle and inner ear progresses in these patients, the surgical complications that often occur severely limit the chances for a satisfactory outcome. Given that known risk, it’s logical to at least consider performing CI surgery earlier in the disease process in such patients, rather than opting for stapes surgery or hearing aids and follow-up, according to Paul Merkus, MD, PhD, associate professor of otolaryngology and neurotology and a member of the VU University Medical Center Cochlear Implant team in Amsterdam, The Netherlands.
The algorithm divides patients into three groups based on audiometry testing: those with maximum speech determination (SD) scores of less than 30 percent, 30 percent to 50 percent and 50 percent to 70 percent. Based on two other key findings, CT scans of the middle ear and the extent of the air-bone gap (ABG), patients are treated with one of those three primary interventions (Laryngoscope. 2011;121:1935-1941).