Conventional Reporting Standards Conceal High‐Frequency Hearing Deficits After Favorable Ossiculoplasty

Abstract

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.