الفهرس 
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Abstract
Otosclerosis is an autosomal-dominant, hereditary disease (25-40% penetrance) of the otic capsule, in which compact bone is remodeled to vascularized, spongy bone, causing stapes fixation and HL.
Patients usually present in their 2nd – 4th decades of life, with gradual onset, slowly progressing bilateral HL. They may have a positive family history, hyperacusis Willisi, low monotonous speech, tinnitus and/or vertigo. When examined, patients are found with a negative Rinne test, a falsely lateralized Weber’s test, and normal, or rarely, Schwartze sign on otoscopy. PTA often reveals gradual low to high frequencies CHL with ABG widening, and a Carhart’s notch at 2 KHz frequency. Excellent SDS and As type tympanogram are also often seen. Surgical treatment remains gold-standard. Malcrimping, however, accounts for 85% of revision surgery.
The aim of this 6-month prospective study was to compare hearing results between GIC-intervened otosclerotic patients and non-GIC intervened ones during the crimping step of primary stapedotomy, at the Otorhino-laryngology Department in Alexandria Main University Hospital
Thirty patients diagnosed with otosclerosis were randomly selected at the out-patient clinic, 15 of who were assigned to intervention group A, and the other 15 to control group B. Classical primary stapedotomy was the primary intervention for both groups, with additional augmentation of the incus–prosthesis attachment only in group A patients using GIC. The duration of follow up was 2 months, and PTA was performed 2 months post-stapedotomy.
Pure tone thresholds were measured at 0.5KHz, 1KHz, 2KHz, and 4KHz frequencies, and ABG noted. Mean values were used to determine primary outcome measurements which were ABG closure, hearing gain and residual ABG. Statistical data sets used were Chi-square test, Fisher exact test, independent t-test, and Wilcoxon Mann–Whitney test. Results significance was judged at the 5% level.
Overall, the patients’ age ranged between 19 – 55 years with the mean age 37.2 years. Most patients were between 20 – 50 years of age, and the male–to–female ratio was approximately 1:13. Bilateral otosclerosis was seen mainly (73.3%), with 66.7% incidence of moderately severe CHL, 60% incidence of tinnitus and 13.3% incidence of vertigo. Right operated ears were 18 (60%) and left 12 (40%), all of which surgically confirmed with stapes fixation, 6.7% (1 patient) with LPI erosion, and accidental TMP occurring in 6.7% (2 patients)%. CTN had to be severed in 6.7% (1 patient) from group B, resulting in dysgeusia post-operatively. Persistent ABG occurred in 6.7% (1 patient) from group B also, postoperatively.
The mean thresholds were plotted on charts to depict audiograms for overall comparison, and the primary outcomes compared. Hearing gains were more in GIC–intervened subects, with more patients achieving better closure, compared to non-GIC intervened, and significantly less residual ABG in group A. (p=0.007). Functional success wa achieved with a mean AC value 32.2 dB in group A compared to 40.0 dB in group B, and post-operative mean ABG was considerably less in group A (6.2 dB) than group B (13.9 dB) across the 4 frequencies, although not statistically significant. (p=0.12)