Conventional Reporting Standards Conceal High‐Frequency Hearing Deficits After Favorable Ossiculoplasty
Michael B. Gluth, Ryan T. JuddAbstarct
Objective
To evaluate high‐frequency hearing outcomes in ossiculoplasty cases having favorable pure‐tone average outcomes within the reporting range set by current guidelines.
Study Design
Retrospective cohort study.
Setting
Multi‐center tertiary care ossiculoplasty outcome registry.
Methods
From 1679 registry cases, 499 ears with synthetic partial or total ossicular replacement prostheses and postoperative pure‐tone average air‐bone gap (PTA‐ABG) ≤ 15 dB at 0.5, 1, 2, and 3 kHz were included (mean follow‐up, 34.4 ± 35.7 months). Outcomes included postoperative 4‐kHz ABG and frequency‐specific preoperative to postoperative changes in ABG and air‐conduction (AC) thresholds.
Results
Mean postoperative PTA‐ABG was 9.6 ± 3.7 dB. The mean 4‐kHz ABG was larger (18.2 ± 10.9 dB) than ABGs at 0.5 to 3 kHz ( P < .001). Despite meeting success criteria, 51.5% of ears had a 4‐kHz ABG ≥ 20 dB and 26.7% had a 4‐kHz ABG ≥ 25 dB. AC improvement decreased with increasing frequency; gains at 4 to 8 kHz were smaller than at 0.5 to 3 kHz ( P < .001).
Conclusion
Current PTA‐based reporting can suggest ossiculoplasty has been successful while substantial high‐frequency conductive deficits persist. Future modification of hearing outcome reporting standards for conductive hearing loss might benefit from consideration of ≥4‐kHz outcomes.
Level of Evidence
3.