Objective: To evaluate possible increases in bone conduction (BC) hearing thresholds in patients undergoing subtotal petrosectomy (SP) with fat obliteration and blind sac closure of the outer ear canal and subsequent round window vibroplasty. Patients and Interventions: Between 1997 and 2013, 43 patients (45 ears) with combined hearing loss and recurrent chronic otitis or status post formation of a radical cavity underwent SP around 6 months prior to implantation of a Vibrant SoundbridgeTM. Pure tone audiograms (0.5, 1, 1.5, 2, 3, 4, and 6 kHz) prior to SP, after SP, prior to implantation, after implantation, and at first fitting around 5 weeks after implantation were collected and statistically analyzed. Results: The comparison between BC thresholds before SP and at first fitting showed an overall decline during the two-step procedure between 2.8 and 6 dB that was significant (p < 0.05, Student t test) at 2, 3, 4, and 6 kHz. Conclusion: In some cases, SP is the only way to eradicate chronic otitis and to achieve a suitable environment for the implantation of active middle ear implants. The present data demonstrate a relatively small but significant decline in BC thresholds throughout the whole procedure. Knowledge of its extent is mandatory for a correct indication for later implantation of a Vibrant SoundbridgeTM.

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