Audiometric changes following oral versus local gel foam steroid administration after stapedectomy in otosclerosis patients: a retrospective comparative study

This study compared the effects of two postoperative steroid administration routes-oral prednisone versus local intraoperative dexamethasone gel foam-on hearing outcomes and complications following primary stapedectomy for otosclerosis. In this retrospective comparative study, 76 consecutive patients who underwent primary stapedectomy by a single senior surgeon at a tertiary center between 2016 and 2024 were included. Patients received either oral prednisone (50 mg daily for 5 days postoperatively; <i>n</i> = 37) or local dexamethasone (8 mg applied intraoperatively on gel foam; <i>n</i> = 39). Pre- and postoperative audiometric data, demographic characteristics, and postoperative complications were analyzed. Audiometry was performed 6-12 weeks after surgery, assessing air-conduction (AC), bone-conduction (BC), and air-bone gap (ABG) thresholds. Both groups demonstrated significant postoperative AC improvement and comparable ABG closure, with no significant differences in overall AC gain or ABG reduction. BC thresh-olds improved in both groups; however, greater BC gain was observed in the oral steroid group. Postoperative tinnitus and infections occurred more frequently in the local steroid group, while vertigo rates were similar between groups. In conclusion, oral and local steroid administration following primary stapedectomy were associated with comparable improvements in air-conduction and air-bone gap outcomes. Although greater bone-conduction recovery and fewer postoperative complications were observed in the oral steroid group, these findings should be interpreted cautiously given the retrospective design and limited sample size.