Reversal versus classic stapedotomy for otosclerosis: a systematic review and meta-analysis
In brief
Reversal and classic stapedotomy achieve similar hearing success in 1,540 patients
Across 10 studies, the two techniques were similarly likely to close the hearing gap to 10 dB or less. Small average hearing differences favoring reversal were not clinically meaningful, and complication rates did not differ significantly, though some safety trends favored reversal; low-certainty evidence leaves larger randomized trials needed to clarify whether either approach has an advantage.
- Journal
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Q1)
- Published
- 13 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ebraheem Albazee, Omar Altawash, Mohammed Alzeeby, Mohamed Zahran
- PMID
- 42867653
- DOI
- 10.1007/s00405-026-10714-x
Why clinicians should know about it
- Picked for Otorhinolaryngology (paper of the day, 15 October 2026): Reversal vs classic stapedotomy show comparable audiologic outcomes
Abstract
BACKGROUND: Stapedotomy is the standard surgical intervention for otosclerosis, but the optimal sequence of surgical steps remains debated. This systematic review and meta-analysis aims to compare the efficacy and safety of reversal versus classic stapedotomy for otosclerosis. METHODS: A comprehensive search across five databases was conducted up to February 2026 for randomized controlled trials (RCTs) and non-randomized studies (NRS). The primary outcome was audiological success, defined as air-bone gap (ABG) closure to ≤ 10 dB. Secondary outcomes included continuous audiometric parameters and surgical complications. Risk ratios (RRs) and mean differences (MDs) were pooled using a random-effects model. RESULTS: Ten studies (2 RCTs, 8 NRS) involving 1,540 patients were included. There was no significant difference between the reversal and classic techniques in achieving an ABG ≤ 10 dB (RR: 1.02, 95% CI [0.93, 1.13]). While statistically significant differences favored the reversal approach for postoperative ABG (MD: -1.57 dB, 95% CI [- 2.59, - 0.54]) and postoperative air conduction pure-tone average (MD: -1.86 dB, 95% CI [- 3.17, - 0.55]), these differences lacked clinical significance. Regarding safety, no statistically significant differences were observed, although the reversal approach showed favorable trends toward reduced floating footplates (RR: 0.23, 95% CI [0.04, 1.24]) and chorda tympani injuries (RR: 0.54, 95% CI [0.29, 1.00]). CONCLUSION: Reversal and classic stapedotomy demonstrate comparable audiological outcomes, with no statistically significant differences observed in the assessed safety outcomes. However, the certainty of evidence was low for audiological outcomes and very low for complications, precluding definitive conclusions until further large-scale RCTs are available.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.