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Otology/Neurotology

Modern Trends in Otologic Surgery and Implications for Residency Training

Wednesday, October 4, 2023
9:33 AM - 9:39 AM East Coast USA Time
Location: 104BC

    Presenting Author(s)

  • JA

    Jason K. Adams, MD

    Neurotology Fellow
    Mount Sinai Icahn School of Medicine
    New York , NY, United States

    • Co-Author(s)

  • John P. Marinelli, MD

    Resident Physician; Editor, Headmirror's ENT in a Nutshell & OtoRecall
    Brooke Army Medical Center
    San Antonio, TX, United States

  • RD

    Russell W. De Jong, MD

    Resident physician
    Brooke Army Medical Center
    Converse, TX, United States

  • Samuel A. Spear, MD

    Chief, DoD Hearing Center of Excellence
    Defense Health Agency Hearing Center of Excellence
    San Antonio, TX, United States

    • Senior Author(s)

  • IE

    Isaac D. Erbele, MD

    Chief of Neurotology, Associate Program Director
    Brooke Army Medical Center, Joint Base San Antonio, TX
    San Antonio, TX, United States

Disclosure(s):
Jason K. Adams, MD: No relevant relationships to disclose.
Introduction: Paralleling advancements in technology and natural evolution in disease pathogenesis, the surgical practice of otology has dramatically evolved over the past half-century. Epidemiologic studies suggest the incidence of otosclerosis is significantly declining while indications for cochlear implantation (CI) continue to expand. This could bear implications on future expectations for surgical volume within otology and general otolaryngology. In light of these trends, the current study aims to characterize the rates of stapedectomy and ossiculoplasty in the United States over the past decade.

Methods: In this retrospective database review, the Department of Defense (DoD) beneficiary population of more than 9 million persons per year was reviewed for patients undergoing either stapedectomy or ossiculoplasty. The study period included years 2010 to 2019. Linear regression was performed to determine annual rates of change, and Pearson correlation was performed.

Results: A total of 2812 stapedectomies and 6727 ossiculoplasties were performed from 2010-2019. During the study period, stapedectomy decreased at a rate of 2.2% per year (Pearson’s correlation r=-0.89, p< 0.001) and ossiculoplasty decreased by 3.6% per year (r=-0.76, p=0.011). The rate of combined stapedectomy and ossiculoplasty decreased at 2.6% per year (Pearson’s correlation r=-0.83, p=0.003).

Conclusions: Rates of stapedectomy and ossiculoplasty have steadily declined over the last decade across this principally national population. This is in stark contrast to the 6.9% annual increase in CI over the same period, demonstrated in a previous study. Should these trends continue, the volume of annual cochlear implantation is projected to overtake that of stapedectomy and ossiculoplasty combined by 2027. In order to reflect modern trends in otologic practice, and in light of reported underutilization of cochlear implants, consideration should therefore be made to replace "Stapedectomy/Ossiculoplasty" with "Cochlear Implant" as a key indicator procedure for otolaryngology residency.