Diagnostic Value of the Air-Bone Threshold Gap in Stapes Fixation

Audiol Neurootol. 2023;28(4):255-261. doi: 10.1159/000528826. Epub 2023 Feb 8.


Introduction: The Carhart notch is a well-known sign of stapes fixation. However, previous studies have reported that the Carhart notch is not specific to stapes fixation and is also present in other middle ear diseases. Therefore, this study investigated the diagnostic value of threshold gap between air conduction and bone conduction (ABG) for stapes fixation, instead of the bone conduction dip representing the Carhart notch.

Methods: A total of 199 ears that underwent exploratory tympanotomy were enrolled in this retrospective study. They were categorized into three groups according to surgical findings: stapes fixation (SF), other ossicle fixation (OF), and chain disconnection (CD). Preoperative pure-tone audiograms and impedance audiograms were compared between the groups.

Results: The incidence of the Carhart notch did not differ between the groups. The ABG at 2,000 Hz showed a good diagnostic performance for distinguishing between the SF and CD groups (area under the curve, AUC = 0.816, p < 0.001), but poor performance for distinguishing between the SF and OF groups (AUC = 0.662, p = 0.003). Bone conduction at 2,000 Hz showed a moderate performance for distinguishing between the SF and CD groups (AUC = 0.707, p < 0.001) and did not show statistically significant results for distinguishing between the SF and OF groups (AUC = 0.594, p = 0.080). The tympanic membrane compliance was significantly higher in the CD group than in the SF group (p = 0.001).

Conclusions: The Carhart notch was not a specific finding of SF. The sensitivity and specificity of ABG ≤15 dB at 2,000 Hz for distinguishing between SF and CD were 60.4% and 89.2%, respectively. To prepare for surgical interventions in patients with conductive hearing loss but a normal tympanic membrane, clinicians should comprehensively consider these results.

Keywords: Otosclerosis; Pure-tone audiometry; Stapes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Audiometry, Pure-Tone / adverse effects
  • Audiometry, Pure-Tone / methods
  • Auditory Threshold
  • Bone Conduction
  • Hearing Loss, Conductive / diagnosis
  • Hearing Loss, Conductive / etiology
  • Hearing Loss, Conductive / surgery
  • Humans
  • Otosclerosis* / surgery
  • Retrospective Studies
  • Stapes
  • Stapes Surgery* / methods
  • Treatment Outcome