Innovative treatment and diagnostic algorithm for otosclerosis

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Abstract

Background. To date, the lack of modern algorithms for the diagnosis and treatment of various forms of otosclerosis (OS) leads to progressive bilateral hearing loss, failures and complication during the operation and disability of the socially active part of the population. The development of a modern therapeutic and diagnostic algorithm for various forms of OS is an urgent topic, the development of which became possible due to the advent of modern medical technologies: high-resolution computed tomographs, microscopes, endoscopes, surgical lasers and motor systems.

Aims — to develop an innovative treatment and diagnostic algorithm for various forms of otosclerosis.

Methods. In a non-randomized controlled prospective study, the results of the examination, treatment and follow-up of 2,421 patients with OS in the period from 2009 to 2022 were analyzed. Conservative inactivating therapy was performed in 288 patients with active and 28 with cochlear forms of OS. Stapedoplasty was performed in 2,393 patients. A partial stapedectomy was performed in group 1, a piston stapedoplasty technique was performed in group 2, and a wide stapedotomy was performed in group 2. In all cases, the operation was performed with CO2 laser assistance (Acuspot 30C, Lumenis, USA). In the obliterating form of OS, various stapedoplasty techniques were performed, depending on the stage, with various means of assistance (the Skeeter Otologic Drill System motor System (Medtronic Xomed, USA) and a CO2 laser. When the active form was detected, piston stapedoplasty with CO2 laser assay was performed. The evaluation of the functional results of the developed methods of stapeplasty (stapedoplasty) was carried out according to the tonal data. Results. For the first time, based on the results of examination, treatment and treatment of a significant number of patients (2421), a modern therapeutic and diagnostic algorithm and a new clinical and radiological classification for OS have been developed. In a comparative assessment of the functional effectiveness of the developed stapedoplasty techniques, the best results were obtained after performing partial stapedectomy and wide stapedotomy (groups 1 and 3) — “excellent” results were achieved after 3 months in 96% of patients, and with piston (group 2) — after 6 months in 78% with a closure of less than 10 dB (p ≤ 0.05). Cochlear complications in the early postoperative period were detected in 0.8% of patients and recurrence of hearing loss in the long-term period in 1%.

Conclusions. The accumulated many years of experience in examining and surgical treatment of patients with OS allowed us to develop an algorithm for diagnosis, treatment and a new clinical and radiological classification, which led to an increase in the frequency of diagnosis of OS and the effectiveness of treatment of hearing loss in patients with various forms of OS.

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About the authors

Andrey I. Kryukov

Sverzhevskiy Otorhinolaryngology Healthcare Research Institute; Pirogov Russian National Research Medical University (Pirogov Medical University)

Email: nikio@zdrav.mos.ru
ORCID iD: 0000-0002-0149-0676
SPIN-code: 9393-8753

MD, PhD, Professor, Corresponding Member of the RAS

Russian Federation, Moscow; Moscow

Natalia L. Kunelskaya

Sverzhevskiy Otorhinolaryngology Healthcare Research Institute; Pirogov Russian National Research Medical University (Pirogov Medical University)

Email: nlkun@mail.ru
ORCID iD: 0000-0002-2581-4006
SPIN-code: 9282-6970

MD, PhD, Professor

Russian Federation, Moscow; Moscow

Yvgeniy V. Garov

Sverzhevskiy Otorhinolaryngology Healthcare Research Institute; Pirogov Russian National Research Medical University (Pirogov Medical University)

Email: egarov@yandex.ru
ORCID iD: 0000-0003-2473-3113
SPIN-code: 1566-9994

MD, PhD, Professor

Russian Federation, Moscow; Moscow

Viktoria N. Zelenkova

Sverzhevskiy Otorhinolaryngology Healthcare Research Institute

Author for correspondence.
Email: zelenkova.07.78@mail.ru
ORCID iD: 0000-0002-5103-1080
SPIN-code: 4389-3337

MD, PhD

Russian Federation, 18a bldg 2 Zagorodnoe higway, 117151 Moscow

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Supplementary files

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2. Fig. 1. Average values of the bone-air interval (A) and auditory thresholds for bone conduction (B) in patients of group 1 before surgery, on day 7, 3 and 12 months after surgery (n = 854)

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3. Fig. 2. Average values of bone-air interval (A) and auditory thresholds for bone conduction (B) in patients of group 2 before surgery, on day 7, 3 and 12 months after surgery (n = 316)

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4. Fig. 3. Average values of bone-air interval (A) and auditory thresholds for bone conduction (B) in patients of group 3 before surgery, on day 7, 3 and 12 months after surgery (n = 1175)

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5. Fig. 4. Therapeutic and diagnostic algorithm for otosclerosis

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