A reevaluation of the 512-Hz Rinne tuning fork test as a patient selectioncriterion for laser stapedotomy

Objective: This study aimed to challenge the classical hypothesis that a ne gative preoperative 512-Hz Rinne tuning fork test (bone conduction greater than air conduction) is a necessary condition to allow consistent objective and subjective hearing improvement with surgery for otosclerosis. Study Design: The study design was retrospective (chart review and question naire). Setting: The study was conducted at a Florida Ear and Sinus Center at Saras ota, Florida, a tertiary otology-neurotology referral center. Patients: Patients who underwent primary laser stapedotomy with equivocal ( air = bone) preoperative 512-Hz Rinne test results participated. Intervention: KTP laser stapedotomy was performed. Main Outcome Measures: Audiologic measurements of air-bone gap closure and patient assessment of hearing improvement and satisfaction were conducted. Results: The air-bone gap was closed to within 10 dB in all cases. There we re no complications. Eighteen patients were questioned about their results. Hearing improvement was subjectively described as "excellent" or "good" by 17 (94%), and 16(89%) thought the surgery was "absolutely" worthwhile. Conclusions: The preoperative 512-Hz Rinne test results need not be negativ e to achieve significant air-bone Sap closure and subjective appreciation o f improved hearing.