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Stapedectomy has success rates ranging from 80% to 95%. [5] [6]Stapedectomy closes what is called the "air bone gap" very efficiently, meaning it restores efficient conduction of sound coming through the air close to the level of the best ability of the nerve cells to perceive the sound.
As pure-tone audiometry uses both air and bone conduction audiometry, the type of loss can also be identified via the air-bone gap. Although pure-tone audiometry has many clinical benefits, it is not perfect at identifying all losses, such as ‘dead regions’ of the cochlea and neuropathies such as auditory processing disorder (APD).
Bone conduction hearing aids are useful as these deliver sound directly, through bone, to the cochlea or organ of hearing bypassing the pathology. These can be on a soft or hard headband or can be inserted surgically, a bone anchored hearing aid, of which there are several types. Conventional air conduction hearing aids can also be used.
Negative Rinne; bone conduction > air conduction (bone/air gap) Other, more complex, tests of auditory function are required to distinguish the different types of hearing loss. Bone conduction thresholds can differentiate sensorineural hearing loss from conductive hearing loss.
The hearing loss is commonly mixed and can be of any degree when first identified. The conductive component is due to a third window effect caused by the widened vestibular aqueduct. During an audiologic assessment, an air-bone gap in the low frequencies can occur due to the enlarged vestibular aqueduct acting as a third mobile window.
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Air conduction uses the apparatus of the middle ear (pinna, eardrum and ossicles) to amplify and direct the sound to the cochlea, whereas bone conduction bypasses some or all of these and allows the sound to be transmitted directly to the inner ear albeit at a reduced volume, or via the bones of the skull to the opposite ear.
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