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Involvement of the Internal Auditory Canal in Subjects With Cochlear Otosclerosis

A Less Acknowledged Third Window That Affects Surgical Outcome

Shim, Ye Ji*; Bae, Yun Jung; An, Gwang Seok; Lee, Kyogu; Kim, Yoonjoong§; Lee, Sang-Youp§; Choi, Byung Yoon§; Choi, Byung Se; Kim, Jae Hyoung; Koo, Ja-Won§; Song, Jae-Jin§

doi: 10.1097/MAO.0000000000002144
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Objective: To investigate the effects of cavitating lesions involving the internal auditory canal (IAC) in subjects with cochlear otosclerosis with regard to poststapedotomy hearing outcome.

Study Design: Retrospective study.

Setting: Tertiary referral center.

Patients: A retrospective chart review of 134 subjects with otosclerosis treated from January 2011 to June 2017 at Seoul National University Bundang Hospital was conducted. Sixteen subjects (23 ears) with temporal bone computed tomography (TBCT)-confirmed cochlear otosclerosis who underwent stapedotomy were included in the study.

Main Outcome Measures: Pure tone audiometry (PTA) (i.e., air and bone conduction; AC and BC, respectively) thresholds and air–bone gap (ABG), measured at 6 months postoperatively were compared between cochlear otosclerosis with and without IAC involvement (IAC group and non-IAC group, respectively).

Results: A total of 14 of 23 ears showed involvement of the IAC. There were no significant differences in age, side of otosclerosis, or preoperative hearing threshold between the two groups. The mean postoperative AC and BC thresholds and ABG of the IAC group were significantly poorer (45.7 dB, 33.8 dB, and 11.8 dB, respectively) than those of the nonIAC group (24.1 dB, 20.0 dB, and 4.1 dB, respectively).

Conclusions: Cochlear otosclerosis with cavitating lesions involving the IAC showed significantly poorer postoperative audiological outcomes than those without any cavitating lesion. Cavitation extending to the IAC may act as a third window providing a route for sound energy shunting, and thus precluding successful hearing outcome in some subjects with cavitating otosclerosis after stapedotomy.

*Department of Otorhinolaryngology—Head and Neck Surgery, Seoul National University, Hospital Healthcare System Gangnam Center, Seoul

Department of Radiology, Seoul National University Bundang Hospital, Seongnam

Music and Audio Research Group, Graduate School of Convergence Science and Technology, Seoul National University, Seoul

§Department of Otorhinolaryngology—Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

Address correspondence and reprint requests to Jae-Jin Song, M.D., Ph.D., Department of Otorhinolaryngology—Head & Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea; E-mail:,

YJS and YJB contributed equally to this study.

The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see:

This work was supported by a grant from the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (grant number 2016R1C1B2007911).

The authors report no conflicts of interest.

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