A Nonrandomized Comparison of Stapes Surgery With and Without a Vein Graft in Patients With Otosclerosis

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To evaluate the effectiveness of primary stapes surgery with and without a vein graft in patients with otosclerosis and to determine the differences in the postoperative gain in air-bone gap (ABG) and air-conduction (AC).

Study Design

A nonrandomized multicenter clinical evaluation.


Two tertiary referral centers in The Netherlands and France.


Otosclerosis patients that underwent primary stapedotomy surgery.


Primary stapedotomy surgery without a vein graft (n = 939, first center) compared with primary stapedotomy surgery with a vein graft (n = 3691, second center).

Main Outcome Measures

Preoperative and postoperative audiometric results were compared. An analysis of variance was performed to evaluate differences in postoperative ABG and AC gains between surgeries with and without a vein graft, adjusted for potential confounders.


The postoperative ABG was 10 dB or lesser in 72.1% of the patients without a vein graft and in 93.2% of patients with a vein graft. After adjustments for differences at baseline, the mean gain in ABG was 18.6 dB (95% CI, 18.1–19.1) in the group without vein graft, compared with 24.2 dB (95% CI, 23.9–24.6) in the group with vein graft (mean difference, 5.6 dB; 95% CI, 5.0–6.2). The mean gain in AC was 19.5 dB (95% CI, 18.7–20.3) in the group without vein graft, compared with 24.3 dB (95% CI, 23.7–24.7) in the group with vein graft (mean difference, 4.8 dB; 95% CI, 3.8–5.7).


Patients with otosclerosis undergoing primary stapes surgery may benefit more from a vein graft interposition.

Level of Evidence


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