Prognostic Factors in Cochlear Implant in Otosclerosis: Radiologic and Clinical Variables: Cochlear Implant Predictors in Otosclerosis.

OBJECTIVE: This study aimed to determine whether radiologic and clinical data can predict the cochlear implant (CI) benefit in patients with otosclerosis, with a focus on the prognostic value of computed tomography (CT) features and relevant clinical variables. METHODS: A retrospective single-centre analysis was conducted on 126 otosclerotic patients (143 implanted ears) who underwent CI between 2009 and May 2025. Preoperative and postoperative CT scans were reviewed and classified using established grading systems (Symons/Fanning, Rotteveel, Veillon). Clinical variables included age at implantation, duration of hearing loss (HL), preoperative audiometric thresholds, history of stapes surgery, electrode design, and scala of insertion. Audiological outcomes were evaluated at 12 months postactivation using aided pure tone average and aided speech perception score. Univariate and multivariate statistical analyses were performed. RESULTS: No significant correlation was found between CT-based otosclerosis staging or radiologic features and post-CI audiological outcomes. Multivariate analysis identified increased age at implantation, electrode insertion into the scala vestibuli, and use of straight electrodes as predictors of poorer speech perception. A longer duration of HL also negatively impacted outcomes. Precurved electrodes and scala tympani placement were associated with superior results. Previous successful stapes surgery predicted better performance. CONCLUSIONS: While CI provides effective auditory rehabilitation in otosclerotic patients, radiologic CT staging does not predict functional outcomes. Instead, clinical factors-age, duration of HL, electrode design, and array placement-are more influential. Preoperative CT remains essential for surgical planning, but patient counselling should focus on clinical history and procedural details. LEVEL OF EVIDENCE: Level III.