The treatment of patients with otosclerosis. From expert opinion to evidence-based practice

Finishing this thesis we summarize the findings from the thesis chapters and conclude that we were able to add usable new information to the otosclerosis field. We took the initiative to aim for a more standardized treatment approach with a step-by-step guideline instruction manual (chapter 2 ). This will help the clinician to manage and rate large amounts of literature and to answer clinical questions. Following this, we showed that stapes surgery under local anesthesia could be a reasonable option compared to stapes surgery under general anesthesia (chapter 3 ). However, due to weak evidence, this subject (local/general anesthesia) could be considered as an evidence gap and a randomized controlled trial should be initiated. When looking at the diagnostic course of patients with conductive hearing loss, the diagnostic value of an audiogram, with or without a Carhart notch, is limited for ruling in or ruling out otosclerosis (chapter 4 ). The presence of a Carhart notch is not a solid diagnostic tool for ruling in otosclerosis but the diagnostic certainty will improve. In chapter 5 , we evaluated and rated the available genetic literature concerning otosclerosis and we were not able to find consistent evidence supporting a uniform genetic effect. To our opinion genetic otosclerosis research is unlikely to have a clinical relevance in the near future. Especially chapter 6, 7 and 8 will help to improve future otosclerosis guidelines. In chapter 6 we showed that it is possible to generate a predictive model within the otosclerosis field. ‘Age at surgery’, ‘preoperative mean air-conduction thresholds’ and ‘preoperative mean air-bone gap’ were identified as independent prognostic predictors. Such a prognostic model will help to aim for personalized care. In chapter 7 the KTP laser and the CO2 laser were compared. It seemed plausible that the application of the CO2 laser could be associated with improved postoperative results, compared to the application of the KTP laser. In chapter 8 the effect of a vein graft was evaluated and revealed that patients with otosclerosis undergoing stapes surgery may benefit more from a vein graft interposition. Although it will take a lot of time to achieve a standardized approach of patients with otosclerosis, this process could not be ignored during the coming years and the aforementioned information will help to achieve standardization