Objective: The aim of this study was to evaluate changes in bone conduction thresholds before, during and after total stapedectomy. Study Design: Prospective clinical study. Methods: In 27 ears of 26 patients undergoing stapedectomy under local anesthesia, bone conduction was measured before surgery, during surgery under open oval window conditions, and after the insertion of a steel wire connective tissue prosthesis. Statistical data analysis was performed on the audiometric results. Results: Under open oval window conditions, bone conduction hearing was found to be improved between 500 and 2000 Hz, but not at 4000 Hz. After insertion of the prosthesis, an additional improvement was evident at 500 and 1000 Hz, but a loss was seen at 2000 and 4000 Hz. Conclusion: This is the first investigation reported in which audiometry was performed under open oval window conditions during stapes surgery. Our results demonstrate that at least part of the preoperative bone conduction hearing loss in otosclerosis must be of mechanical, but not of sensorineural origin, as already suspected by Carhart. The fixed footplate suppresses cochlear micromechanics mainly at frequencies between 500 to 2000 Hz. Furthermore, the loss in bone conduction hearing at 2000 and 4000 Hz after insertion of the prosthesis indicates that rather than the surgical procedure of total removal of the footplate, other factors such as the handling of the prosthesis or its mechanical properties after insertion cause high-frequency hearing loss after stapes surgery.

Arnold W, Ferekidis E, Hamann KF: The influence of the footplate-perilymph interface on postoperative bone conduction. Adv Otorhinolaryngol 2007;65:155–157.
Arnold W, Friedmann I: Otosclerosis – An inflammatory disease of the otic capsule of viral aetiology? J Laryngol Otol 1988;102:865–871.
Awengen DF: Change of bone conduction thresholds by total footplate stapedectomy in relation to age. Am J Otolaryngol 1993;14:105–110.
Bretlau P, Bloch M, Sorensen MS: Stapedotomy outcome: Nitinol piston versus Fisch piston. 2nd Int Symp of the Polizer Soc on Otoscler and Stapes Surg, Biarritz, 2008.
Bretlau P, Chevance LG, Causse J, Jorgensen MB: Bone resorption in otospongiosis. Am J Otol 1982;3:284–289.
Carhart R: Assessment of sensorineural response in otosclerotics. AMA Arch Otolaryngol 1960;71:141–149.
Carhart R, Hayes C: Clinical reliability of bone conduction audiometry. Laryngoscope 1949;59:1084–1101.
Causse JR, Causse JB, Bretlau P, Uriel J, Berges J, Chevance LG, Shambaugh GE, Bastide JM: Etiology of otospongiotic sensorineural losses. Am J Otol 1989;10:99–107.
Causse JR, Chevance LG: Sensorineural hearing loss due to cochlear otospongiosis: etiology. Otolaryngol Clin North Am 1978;11:125–134.
Fisch U: Stapedotomy versus stapedectomy. Am J Otol 1982;4:112–117.
Laukli E, Fjermedal O: Reproducibility of hearing threshold measurements. Supplementary data on bone-conduction and speech audiometry. Scand Audiol 1990;19:187–190.
Lightfoot GR, Hughes JB: Bone conduction errors at high frequencies: implications for clinical and medico-legal practice. J Laryngol Otol 1993;107:305–308.
Merchant SN, Rosowski JJ: Conductive hearing loss caused by third-window lesions of the inner ear. Otol Neurotol 2008;29:282–289.
Merchant SN, Rosowski JJ, McKenna MJ: Superior semicircular canal dehiscence mimicking otosclerotic hearing loss. Adv Otorhinolaryngol 2007;65:137–145.
Minor LB: Superior canal dehiscence syndrome. Am J Otol 2000;21:9–19.
Perez R, de Almeida J, Nedzelski JM, Chen JM: Variations in the ‘Carhart notch’ and overclosure after laser-assisted stapedotomy in otosclerosis. Otol Neurotol 2009;30:1033–1036.
Persson P, Harder H, Magnuson B: Hearing results in otosclerosis surgery after partial stapedectomy, total stapedectomy and stapedotomy. Acta Otolaryngol 1997;117:94–99.
Ramsden R, Rotteveel L, Proops D, Saeed S, van Olphen A, Mylanus E: Cochlear implantation in otosclerotic deafness. Adv Otorhinolaryngol 2007;65:328–334.
Rosowski JJ, Songer JE, Nakajima HH, Brinsko KM, Merchant SN: Clinical, experimental, and theoretical investigations of the effect of superior semicircular canal dehiscence on hearing mechanisms. Otol Neurotol 2004;25:323–332.
Schuknecht HF: Cochlear otosclerosis. An intractable absurdity. J Laryngol Otol Suppl 1983;8:81–83.
Sohmer H, Freeman S, Perez R: Semicircular canal fenestration – Improvement of bone- but not air-conducted auditory thresholds. Hear Res 2004a;187:105–110.
Sohmer H, Sichel JY, Freeman S: Cochlear activation at low sound intensities by a fluid pathway. J Basic Clin Physiol Pharmacol 2004b;15:1–14.
Stenfelt S, Goode RL: Bone-conducted sound: physiological and clinical aspects. Otol Neurotol 2005;26:1245–1261.
Stenfelt S, Puria S, Hato N, Goode RL: Basilar membrane and osseous spiral lamina motion in human cadavers with air and bone conduction stimuli. Hear Res 2003;181:131–143.
Sziklai I, Batta TJ, Karosi T: Otosclerosis: an organ-specific inflammatory disease with sensorineural hearing loss. Eur Arch Otorhinolaryngol 2009;266:1711–1718.
Topsakal V, Fransen E, Schmerber S, Declau F, Yung M, Gordts F, Van Camp G, Van de Heyning P: Audiometric analyses confirm a cochlear component, disproportional to age, in stapedial otosclerosis. Otol Neurotol 2006;27:781–787.
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