Hearing loss with stapedotomy in otitis media

Abstract

Objective Stapes fixation is often found in patients with either active or inactive otitis media (OM). Stapedotomy is generally not performed in ears with OM because of the potential risk of sensorineural hearing loss (SNHL). Recent studies have demonstrated that the inner ear may be fenestrated in the presence of OM without significantly increased risk of SNHL. The goal of this study was to determine if stapedotomy in the presence of OM significantly increases the incidence of postoperative SNHL. Methods Streptococcus pneumoniae or Pseudomonas aeruginosa was injected bilaterally into the middle ears of guinea pigs (n = 18 and 16, respectively). A control group (n = 14) was injected with saline solution. Two days postinjection, a unilateral stapedotomy was performed. Auditory thresholds were evaluated by electrocochleography before and after stapedotomy. Results Bacterial OM was induced in all ears injected with pneumococci and pseudomonas. Auditory thresholds increased in all ears treated with stapedotomy. Stapedotomy performed in the presence of pseudomonas OM resulted in significantly greater SNHL than in control or pneumococcal ears ( P = 0.0055). Hearing thresholds were not significantly different between pneumococcal OM and control ears treated with stapedotomy. Conclusion Stapedotomy in the presence of pseudomonas OM, but not pneumococcal OM, significantly increases the risk of SNHL in the guinea pig model. Significance Stapedotomy should be avoided in patients with active OM, particularly in the presence of pseudomonas.