Navid Shahnaz* Neil Longridge § Desmond Bell $ *School of Audiology & Speech Sciences, University of British Columbia, Vancouver, Canada § Division of Otolaryngology, Vancouver General Hospital, Vancouver, Canada $ ENT Clinic, Lions Gate Hospital, North Vancouver, Canada Key Words Wideband energy reflectance Otosclerosis Energy reflectance Stapedectomy Stapes Stapedotomy Preoperative Post-operative Air conduction Air-bone gap Abbreviations ABG: Air-bone gap AC: Air conduction ER: Energy reflectance TEOAE: Transient-evoked otoacoustic emission WBR: Wideband reflectance Original Article International Journal of Audiology 2009; 48:240247 Wideband energy reflectance patterns in preoperative and post-operative otosclerotic ears Abstract The purpose of this study was to examine patterns of energy of reflectance (ER) in preoperative and post- operative conditions in otosclerotic ears. It was also within the scope of this paper to investigate whether the changes in ER pattern post-operatively correlate to the improvement in hearing as measured by pure-tone audiometry. ER was measured in 15 surgically confirmed otosclerotic ears (mean age: 44 years) before and after the stapes surgery. The most prominent change in ER pattern following the surgery in majority of the subjects was a sharp and deep drop in ER value between 7001000 Hz. There was also a secondary wider and smaller increase in ER value following the surgery between 20004000 Hz. Moreover, in most cases the drop in ERvalues following the surgery at low frequencies ( 51000 Hz) approximated the mean ER values in the normal group. Comparison of ER patterns with hearing improvement as measured by air conduction averaged across low (2501000 Hz) and high (20006000 Hz) frequency bands before and after the surgery did not reveal any significant correlation. However, there was a general positive correlation trend for ER changes in low frequency band and AC changes, especially for high frequency bands. Changes in ER pattern may potentially be useful as an objective tool for monitoring the impact of the stapes reconstructive surgery and evaluating different surgical protocol. Sumario El propo ´sito de este estudio fue examinar los patrones de energı ´a reflectante (ER) en el pre y postoperatorio en oı ´dos con otoesclerosis. Ası ´ mismo, en este trabajo se investigo ´ si los cambios en el patro ´n postoperatorio de ER se correlacionan con el mejoramiento de la audicio ´n medida por medio de audiometrı ´a tonal. La ER fue medida en 15 oı ´dos en los que se confirmo ´ la otoesclerisis quiru ´ rgicamente (media de edad: 44 an ˜ os) antes y despue ´s de la cirugı ´a estapedial. El cambio ma ´s prominente en el patro ´n ER despue ´s de la cirugı ´a en la mayorı ´a de los sujetos fue una clara y profunda caı ´da el valor de ER entre 700 y 1000Hz. Tambie ´n hubo un aumento secun- dario, ma ´s ancho y pequen ˜o en el valor ER despue ´s de la cirugı ´a, entre 20004000 Hz. Incluso, en la mayorı ´a de los casos la caı ´da de los valores ER despue ´s de la cirugı ´a en las frecuencias bajas ( 51000Hz) se aproximo ´ a los valores ER promedio en el grupo normal. La comparacio ´ n de los patrones ER de los que tuvieron mejorı ´a auditiva, medidos por conduccio ´n ae ´rea promediada en la banda de frecuencias bajas (2501000Hz) y la de altas (2000 6000Hz), antes y despue ´s de la cirugı ´a, no demostro ´ ninguna correlacio ´n significativa. Sin embargo, sı ´ hubo una tendencia positiva de correlacio ´ n entre los cambios ER en la banda de bajas frecuencias y los cambios AC, especialmente para las bandas de frecuencia elevada. Los cambios en los patrones ER pueden ser potencialmente u ´tiles como una herramienta objetiva para monitorear el impacto de la cirugı ´a de reconstruccio ´ n estapedial y para evaluar diferentes protocolos quiru ´rgicos. This paper is a follow up to the manuscript published in Ear and Hearing journal (Shahnaz et al, 2009). Stapes replacement surgery, commonly known as stapedectomy, is one of the most common types of the middle-ear surgery conducted in adults to restore the hearing in cases of otosclerosis. Since its first inception in 1956 (Shea, 1998), stapedectomy has undergone several modifications varying from stapedectomy (large fenestra) to stapedotomy (small fenestra) procedures (Ferekidis, 2007). Stapes surgery can significantly alter mechanical and acoustical properties of the middle ear by modifying anatomical structures such as annular ligament which is the major contributing factor of the middle-ear impedance (Hu ¨ ttenbrink, 2003). The development of multifrequency, multi-component admit- tance devices has made it possible to record admittance across a wide range of frequencies and to measure the relative contribu- tion of stiffness, mass, and frictional elements. These elements are represented by susceptance and conductance which are sub-components of an admittance tympanogram. Colletti et al (1993) examined the susceptance tympanogram at multiple frequencies in 138 subjects who had undergone stapedectomy. They reported significant reduction of resonant frequency in otosclerotic ears post-operatively. Valviket al (1994) were able to test 21 otosclerotic ears pre- and post-operatively. They found that resonant frequency in preoperative otosclerotic ears was significantly lower than post-operative otosclerotic ears and normal ears. (Note, only five post-operative otosclerotic ears were from their preoperative otosclerotic group). They attributed this to a reduction of stiffness or an increase of the mass in the middle-ear system of post-operative otosclerotic ears, and suggested these findings may indicate that the middle ear of otosclerotic ears is not completely restored to normal following surgery. While tympanometry can provide an objective means to assess the middle-ear mechanical and acoustical properties following stapedectomy, it could also alter the middle-ear transmission properties. The pressure change required for tympanometry can ISSN 1499-2027 print/ISSN 1708-8186 online DOI: 10.1080/14992020802635317 # 2009 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society Received: June 3, 2008 Accepted: November 19, 2008 Navid Shahnaz School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia, 2177 Westbrook Mall, Friedman Building, Vancouver, BC, V6T 1Z3, Canada. E-mail: nshahnaz@audiospeech.ubc.ca