Hearing preservation in otosclerosis: Codacs versus CI

Abstract: Introduction: Advanced otosclerosis can be associated with important changes in the otic capsule. Cochlear implantation with a minimal atraumatic insertion can be difficult. The alternatives are stapedotomy with conventional hearing aid and the use of a direct acoustic cochlear implant (DACI). The latter is a combination of a stapes prosthesis with a powerful acoustic hearing implant. The aim of this study was to retrospectively compare two groups of advanced otosclerosis subjects. Methods: Subjects: patients with advanced otosclerosis were compared in an observational retrospective study design. Ten subjects received a cochlear implant, 5 subjects a Codacs device. Analysis: speech in noise, speech in quiet in comparison to the preoperative pure tone audiometry. Results: DACI subjects showed a clear improvement already at 1 month post-fitting which was statistically significant in comparison to CI subjects regarding the speech understanding in noise and in quiet. At 12 months, with intensive CI training, this difference was not significant anymore in this limited group of subjects. A short review of the current management options for advanced otosclerosis will be given. Conclusion: In addition to the consensus in literature, for advanced otosclerosis, there seems to be an advantage in keeping the acoustic component before a cochlear implantation is carried out. Because of round window obliteration and basal window narrowing, an atraumatic electrode insertion can be challenging.status: publishe