Sarcouncil Journal of Medicine and Surgery

Abstract: Background: Otosclerosis is a primary osteodystrophy of the otic capsule involving abnormal bone remodeling, which causes progressive conductive and mixed hearing loss. Hypothesis: The aim of this study was to assess the clinical, audiologic, and surgical results of 109 patients with otosclerosis undergoing current surgical procedures, Methods: A prospective cohort study was done at a tertiary otological center from January 2025 to April 2026 in Iraqi hospitals, in which one hundred nine patients were enrolled with the diagnosis of otosclerosis confirmed by surgery. Comprehensive evaluation of the auditory function, High Resolution Computed Tomography (HRCT), genetic screening of TGFB1, COL1A1, RELN, and BMP2/4 polymorphisms, and intraoperative histopathological evaluation were performed. Primary outcomes were closure of air-bone gap (ABG), pure-tone average (PTA) improvements, and complication rates. Paired t-test, chi-square test, and multivariate logistic regression were used for statistical analysis, and the significance was defined as p<0.05. Results: The mean age at presentation was 38.4±9.7 years with a female predominance (63.3%). 22.9% of patients showed bilateral involvement. Preoperative mean ABG was 28.6±8.3 dB and postoperative 7.2±4.1 dB (p<0.001). The success of the ABG closure (≤10 dB) was 91.7% for operated ears. The genetic analysis revealed that 47.7% of patients had polymorphisms in the TGFB1 gene and 31.2% had polymorphisms in COL1A1. There was a significant difference in the mean age of onset between the patients with any TGFB1/COL1A1 variants and the controls (32.1 years compared with 41.3 years, p=0.003), and the patient group with variants had higher bilateral involvement (38.2% vs. 15.7%, p=0.012). The results of stapedotomy with titanium prosthesis were better than those of conventional stapedectomy (ABG closure ≤10 dB: 94.8% vs. 86.4%, p=0.041). Conclusions: The surgery of otosclerosis is performed with excellent results and an adequate postoperative audiological prognosis.