The Cost-effectiveness of Stapes Surgery for Otosclerosis Performed Under Local Versus General Anesthesia (CESSO)

Centre Hospitalier Universitaire de Besancon

Status: Completed

Conditions: Otosclerosis

Treatments: Other: cost-effectiveness and audiometry outcomes

Study type: Observational

Funder types: Other

Identifiers

NCT06618053

2024/879

Details and patient eligibility

About

Otosclerosis is a localized disorder of the otic capsule, characterized by bone resorption anterior to the oval window in the region of the fissula ante fenestram. This process leads to new sclerotic bone formation, resulting in stapes footplate fixation. It is one of the most common causes of progressive conductive hearing loss in young adults between the age of 30 and 50 year-old. As the disease advances, hearing loss can become mixed and even purely sensorineural due to the pathological process extending into the cochlea.

Stapes surgery is the gold standard procedure for restoring mechanical sound transmission through the middle ear. For patients who are not candidates for surgery, hearing aids offer a valid alternative. Over the years, stapes surgery has evolved into a minimally invasive procedure that can be safely performed as day surgery, under either local or general anesthesia.

The COVID-19 crisis has exacerbated a shortage in anesthesiology teams, limiting operating room availability. To address this issue, stapes surgery for otosclerosis under local anesthesia were increasingly performed. Local anesthesia has several advantages: it allows for immediate hearing tests after prosthesis placement, enabling early detection and correction of vertigo caused by prosthesis displacement, thus minimizing major complications. Additionally, local anesthesia reduces exposure to general anesthesia, thereby decreasing postoperative morbidities.

While there are few studies comparing outcomes and complications of stapes surgery based on the type of anesthesia, a systematic review in 2013 found no difference in postoperative air-bone gap (ABG), sensorineural hearing loss (SNHL), or postoperative vertigo between procedures performed under local versus general anesthesia. No studies have evaluated or compared the cost-effectiveness of stapes surgery for otosclerosis performed under local versus general anesthesia.

This study hypotheses that patients undergoing stapes surgery under local anesthesia will have equivalent outcomes to those under general anesthesia, with the potential for reduced costs and operative time.

Enrollment: 40 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients diagnosed with otosclerosis and indicated for stapes surgery.
• Patients who underwent primary stapes surgery between January 1, 2022, and December 31, 2023.
• Surgery performed by utilizing the CO2 laser technique (Stapedotomy).
• Patients with complete medical records and audiometry data.
• Subjects do not object to the use of their personal data.

Exclusion criteria

• Patients with incomplete medical records (pre- or postoperative audiologic data were unavailable).
• Patients with other concurrent middle ear pathologies.
• Patients who underwent revision surgery for otosclerosis.
• performed by utilizing the microdrill technique or stapedectomy.

Trial design

40 participants in 2 patient groups

stapes surgery performed under local anesthesia

Treatment:

Other: cost-effectiveness and audiometry outcomes

stapes surgery performed under general anesthesia

Treatment:

Other: cost-effectiveness and audiometry outcomes