Factors associated with failure in stapes surgery for otosclerosis: a retrospective study in a tertiary care hospital

Abstract BACKGROUND. Otosclerosis is a common cause of conductive hearing loss in adults, most frequently treated with stapes surgery. However, the factors determining surgical success or failure remain controversial. OBJECTIVE. To identify clinical and surgical variables associated with surgical failure in patients undergoing stapes surgery for otosclerosis at a tertiary referral hospital in northwestern Mexico. MATERIAL AND METHODS. An observational, retrospective, cross-sectional study was conducted on 54 patients diagnosed with otosclerosis who underwent surgery between 2022 and 2024. Adult patients with preoperative and 6-month postoperative audiometry were included, while those without audiological follow-up were excluded. Sociodemographic, clinical, surgical, and audiometric variables were analyzed. Surgical failure was defined as a postoperative air–bone gap (ABG) >10 dB. RESULTS. A total of 81.5% of patients achieved surgical success. No significant association was found between surgical failure and age, sex, comorbidities, smoking status, or the type of surgical visualization used. A higher risk of failure was identified in patients who underwent stapedectomy (OR = 13.6, p = 0.001) and in surgeries performed on the left ear. Hearing improved significantly: the global PTA decreased from 59.8 to 40.1 dB (p<0.001, Cohen’s d=4.5). The ABG decreased across all analyzed frequencies, with large effect sizes. CONCLUSION. Stapes surgery is effective in improving hearing in patients with otosclerosis. Intraoperative decisions, particularly the choice of surgical technique (stapedotomy versus stapedectomy), significantly influence outcomes. These findings support stapedotomy as the preferred technique and highlight the importance of standardized audiometric follow-up.