SHORT COMMUNICATION

In search of correlation between hand preference and lateralityof hearing impairment in patients with otosclerosis

Lela Migirov • Michael Wolf

Received: 5 April 2014 / Accepted: 19 June 2014 / Published online: 29 June 2014

� Springer-Verlag Berlin Heidelberg 2014

Abstract The aim of this study was to investigate a

possible correlation between handedness and laterality of

hearing impairment due to otosclerosis. All patients oper-

ated for otosclerosis between August 2008 and February

2014 were queried about their handedness. The study group

consisted of 218 right-handed and 21 left-handed (8.9 %)

patients [139 female (58.2 %) and 100 male] with an age

range of 18–75 years (mean 46.1 years). One-hundred and

fifty-seven patients had a bilateral otosclerosis (BO) and 82

(34.3 %) had a unilateral otosclerosis (UO). There were 11

left-handed male and 10 left-handed female (11 % vs.

7.2 %, p = 0.305). In patients with UO, the left ear (LE)

was affected in 6/11 (58.3 %) left handed ones, and the

right ear (RE) in 41/71 (57.7 %) right handed ones

(p = 0.842). In patients with BO, the LE was more

affected in the left-handed ones, and the RE in the right-

handed ones (7/10, 70 % and 87/147, 59.2 %, respectively,

p = 0.5). Overall, 13/21 (61.9 %) left-handed patients

presented with only/mostly left-sided otosclerosis, while

128/218 (58.7 %) right-handed patients presented with

only/mostly right-sided otosclerosis (p = 0.584). Clinical

relevance of presented findings is unclear yet nevertheless

current study may contribute one more element in the

multifactorial process of otosclerosis-related hearing loss.

Keywords Otosclerosis � Laterality � Handedness �Hearing loss

Introduction

The etiopathogenesis of otosclerosis is a subject of contin-

uous research and it has been proposed to be dependent on

viral, genetic, inflammatory, autoimmune, environmental,

hormonal, and metabolic factors [1–3]. However, these

theories failed to predict the laterality of the ear that will be

first affected by the disease and are out of the focus of current

investigation. It was found in normal listeners that the right

ear (RE) is superior in dichotic listening, monaural speech

stimuli, syntax structure, phoneme discrimination, and

consonant–vowel recognition [4–7], whereas,the left ear

(LE) is supposed to be superior in nonverbal sound presen-

tation, brief melody listening, and intonation discrimination

[4–6]. Bilateral otosclerosis (BO) has been reported in

38.9–90 % patients [8–13]. The RE advantage in right-

handed individuals and the LE advantage in left-handed ones

were demonstrated in individuals with a normal hearing and

in a population with hearing impairment [14–17]. Lateral

preference is the preferential use of one of a pair of bilaterally

symmetrical organs. Handedness is the most obvious lateral

preference. Noonan and Axelrod defined earedness as the

preferential orientation of one ear toward a sound source

[17]. Earedness by this definition can be comparable to

handedness as it is usually defined (the consistent use of one

hand in unimanual tasks). The concordance of earedness

with handedness in 74 % of right-handed and 65 % of left-

handed young adults was reported [17].

Given that around 90 % of human adults are right

handed [18–21], the evidence of RE advantage in right-

handed people [14–16] and the right-sided preponderance

among patients with BO [8], we hypothesized that hand

preference might be one of the factors involved in the

laterality of hearing impairment caused by otosclerosis, and

the current study was conducted to test this hypothesis.

L. Migirov (&) � M. Wolf

Department of Otolaryngology Head and Neck Surgery, Sheba

Medical Center, Affiliated to the Sackler School of Medicine,

Tel Aviv University, 5262l Tel Hashomer, Israel

e-mail: migirovl@gmail.com

123

Eur Arch Otorhinolaryngol (2014) 271:2835–2837

DOI 10.1007/s00405-014-3173-5

Patients and methods

All patients who underwent stapedectomy/stapedotomy for

surgically confirmed otosclerosis in the Department of

Otolaryngology and Head and Neck Surgery in Sheba

Medical Center between October 2008 and February 2014

were asked to report their hand preference for writing,

throwing and brushing teeth. Data of their age, gender, and

hearing impairment were retrieved from their medical

records. The patients’ mean pre-operative hearing level

was calculated as the pure tone average for the frequencies

0.5, 1, 2 and 3 kHz. The study population was grouped into

three categories according to their pre-operative hearing

impairment: unilateral hearing loss (Group 1, 82 patients),

bilateral asymmetrical hearing loss (Group 2, 149 patients),

and bilateral symmetrical hearing loss (Group 3, 8

patients). The difference of 5 dB or more in an air con-

duction level (average for the frequencies 0.5, 1, 2 and

3 kHz) was assumed as asymmetrical hearing loss.

Statistical analysis was performed using the Chi-square

test. The difference was considered to be statistically sig-

nificant at a p value \0.05.

Results

The study group consisted of 218 right-handed and 21 left-

handed (8.9 %) patients (139 female [58.2 %] and 100

male) with an age range of 18–75 years (mean 46.1 years).

The mean age of the left- and right-handed patients was

43.7 and 46.4 years, respectively, and the mean age of

patients with unilateral otosclerosis (UO) and BO was 44.4

and 47.2 years, respectively (p = NS). None of the sub-

jects was ambidextrous.

One-hundred and fifty-seven patients had a bilateral

hearing loss and 82 (34.3 %) had a unilateral hearing loss

attributed to otosclerosis (Table 1). There were 92 female

(58.6 %) with BO and 45 female (54.9 %) with UO. The

proportion of left-handed male was higher than the pro-

portion of left-handed female (11/100, 11 % and 10/139,

7.2 %, respectively, p = 0.305).

In patients with UO, the LE was affected in 6/11

(58.3 %) left handed ones, and the RE in 41/71 (57.7 %)

right handed ones (p = 0.842). In patients with BO, the LE

was more affected in the left-handed ones, and the RE was

more affected in the right-handed ones (7/10, 70 % and

87/147, 59.2 %, respectively, p = 0.5). Overall, 13/21

(61.9 %) left-handed patients presented with only/mostly

left-sided otosclerosis, while 128/218 (58.7 %) right-han-

ded patients presented with only/mostly right-sided oto-

sclerosis (p = 0.584, Table 1).

Discussion

A relatively few articles have focused specifically on the

outcome of stapes surgery in relation to the laterality of

otosclerosis, and no functional difference was found

between a stapedectomy performed in the RE or LE [10,

22]. However, the relation between the laterality of hearing

impairment in otosclerosis and the patient’s handedness

had not yet been investigated.

Hand dominance is defined as the proneness to use one

hand rather than another in performing the majority of

activities, and it is widely accepted that roughly 1 of 10

humans are left handed [18–21]. Handedness has been

attributed to a variety of factors including cultural

demands, parental pressure, genetic factors, and aging [23–

27]. The majority of our study patients (218/239, 91.2 %)

reported being right handed, a finding in agreement with

the studies on hand preferences in different populations

[18–21, 28]. Our findings on female prevalence among the

patients with otosclerosis, mean age at presentation for

stapes surgery and gender differences in handedness were

consistent with those in the literature [2, 3, 8–11, 28–31].

We found that the LE was more affected by otosclerosis

in left-handed subjects, and that the RE in right-handed

subjects with BO as well as in those with UO. Although

this trend did not reach a level of significance, it is con-

sistent with the findings of Lippy and co-workers who

reported that the RE had the larger conductive hearing loss

in 54–61 % of their cases of BO [8]. The knowledge on the

ear that is supposed to be affected in UO or first/more

affected in BO does not exist, and the reason for the lat-

erality of a hearing impairment in patients affected by

unilateral or bilateral otosclerosis remains unclear. More-

over, there still are no explanations for previously reported

Table 1 Hand dominance and laterality of otosclerosis

Right-handed Left-handed Total

Female Male Female Male

Unilateral otosclerosis

RE 24 17 3 2 46

LE 16 14 3 3 36

Total 40 31 6 5 82

Bilateral otosclerosis

RE = LE 5 3 0 0 8

RE [ LE 48 39 0 3 90

LE [ RE 36 16 4 3 59

Total 89 58 4 6 157

Whole study group 129 89 10 11 239

RE Right ear, LE Left ear, RT = LT Symmetrically affected right and

left ears, RT [ LT Right ear was affected more than left ear,LE [ RE

Left ear was affected more than right ear

2836 Eur Arch Otorhinolaryngol (2014) 271:2835–2837

123

ear preferences in individuals with right- or left-hand pre-

dominance [8, 14–16].

A limitation of this report is that it is a hospital-based

observational study that cannot claim to reflect the entire

population of individuals with otosclerosis.

Conclusion

The results of the present investigation failed to demon-

strate a strong relation between the laterality of a hearing

impairment in otosclerosis and the patient’s hand prefer-

ences. Left-hand dominance was, however, associated

mostly with left-sided otosclerosis. Clinical relevance of

current study is unclear yet but it may contribute one more

element in the multifactorial process of otosclerosis-related

hearing loss. Further studies including west number of

patients are required to understand the impact of the

handedness on the laterality of hearing in otosclerosis

patients.

Conflict of interest None.

References

1. Karosi T, Sziklai I (2010) Etiopathogenesis of otosclerosis. Eur

Arch Otorhinolaryngol 267:1337–1349

2. Markou K, Goudakos J (2009) An overview of the etiology of

otosclerosis. Eur Arch Otorhinolaryngol 266:25–35

3. Uppal S, Bajaj Y, Rustom I, Coatesworth AP (2009) Otosclerosis

1: the aetiopathogenesis of otosclerosis. Int J Clin Pract

63:1526–1530

4. Heeschen C, Jurgens R (1977) Pragmatic-semantic and syntactic

factors influencing ear differences in dichotic listening. Cortex

13:74–84

5. Graves RE, Morley S, Marcopulos BA (1987) Measurement of

the dichotic listening ear advantage for intersubject and inter-

stimulus comparisons. J Clin Exp Neuropsychol 9:511–526

6. Noonan M, Axelrod S (1981) Earedness (ear choice in monaural

tasks): its measurement and relationship to other lateral prefer-

ences. J Aud Res 21:263–277

7. Shankweiler D, Studdert-Kennedy M (1967) Identification of

consonants and vowels presented to left and right ears. Quart J

Exp Psychol 19:59–63

8. Lippy WH, Berenholz LP, Burkey JM (1999) Otosclerosis in the

1960s, 1970s, 1980s, and 1990s. Laryngoscope 109:1307–1309

9. Hazenberg AJ, Minovi A, Dazert S, Hoppe FF (2013) Predictors

of listening capabilities and patient satisfaction after stapes sur-

gery in otosclerosis. Otol Neurotol 34:220–226

10. Marchese MR, Conti G, Cianfrone F, Scorpecci A, Fetoni AR,

Paludetti G (2009) Predictive role of audiological and clinical

features for functional results after stapedotomy. Audiol Neu-

rootol 14:279–285

11. Shiao AS, Kuo CL, Cheng HL, Wang MC, Chu CH (2013)

Controversial issues of optimal surgical timing and patient

selection in the treatment planning of otosclerosis. Eur Arch

Otorhinolaryngol Apr 30. [Epub ahead of print]

12. Lundman L, Mendel L, Bagger-Sjoback D, Rosenhall U (1999)

Hearing in patients operated unilaterally for otosclerosis. Self-

assessment of hearing and audiometric results. Acta Otolaryngol

119:453–458

13. Maniu A, Cosgarea M (2013) Technical and functional hearing

results after unilateral stapes surgery for otosclerosis at Cluj-

Napoca University Hospital. Eur Arch Otorhinolaryngol

270:2215–2224

14. Demarest J, Demarest L (1980) Auditory asymmetry and strength

of manual preference reexamined. Int J Neurosci 11:121–124

15. Dane S, Gumustekin K, Polat P, Uslu C, Akar S, Dastan A (2002)

Relations among hand preference, craniofacial asymmetry, and

ear advantage in young subjects. Percept Mot Skills 95:416–422

16. Hannula S, Bloigu R, Majamaa K, Sorri M, Maki-Torkko E

(2012) Ear diseases and other risk factors for hearing impairment

among adults: an epidemiological study. Int J Audiol 51:833–840

17. Noonan M, Axelrod S (1981) Earedness (ear choice in monaural

tasks): its measurement and relationship to other lateral prefer-

ences. J Aud Res 21:263–277

18. Frayer DW, Lozano M, Bermudez de Castro JM, Carbonell E,

Arsuaga JL, Radovcic J, Fiore I, Bondioli L (2011) More than

500,000 years of right-handedness in Europe. Laterality 14:1–19

19. Spivak B, Segal M, Mester R, Weizman A (1998) Lateral pref-

erence in post-traumatic stress disorder. Psychol Med 28:229–232

20. Nachshon I, Denno D, Aurand S (1983) Lateral preferences of

hand, eye and foot: relation to cerebral dominance. Int J Neurosci

18:1–9

21. Raymond M, Pontier D, Dufour AB, Møller AP (1996) Fre-

quency-dependent maintenance of left handedness in humans.

Proc Biol Sci 263:1627–1633

22. Karkas A, Chahine K, Righini CA, Khirnetkina A, Schmerber S

(2009) Right versus left stapes surgery: is there a difference? Otol

Neurotol 30:1067–1070

23. Oldfield RC (1971) The assessment and analysis of handedness:

the Edinburgh Inventory. Neuropsychologia 9:97–113

24. Falek A (1959) Handedness: a family study. Am J Hum Genet

11:52–62

25. Lew J, Nagilaki T (1972) A model for the genetics of handedness.

Genetics 72:117–128

26. Fleminger JJ, Dalton R, Standagek F (1977) Age as a factor in the

handedness of adults. Neuropsychologia 15:471–473

27. Teng EL, Lee PH, Yang KS, Chang PC (1976) Handedness in a

Chinese population: biological, social, and pathological factors.

Science 193:148–150

28. Silverberg R, Obler LK, Gordon HW (1979) Handedness in

Israel. Neuropsychologia 17:83–87

29. Emmett JR (1993) Physical examination and clinical evaluation

of the patient with otosclerosis. Otolaryngol Clin North Am

26:353–357

30. Wiet RJ, Battista RA, Wiet RM, Sabin AT (2013) Hearing out-

comes in stapes surgery: a comparison of fat, fascia, and vein

tissue seals. Otolaryngol Head Neck Surg 148:115–120

31. Van Rompaey V, Yung M, Claes J, Hausler R, Martin C, Somers

T, Offeciers E, Pytel J, Skladzien J, de Heyning PV (2009)

Prospective effectiveness of stapes surgery for otosclerosis in a

multicenter audit setting: feasibility of the Common Otology

Database as a benchmark database. Otol Neurotol 30:1101–1102

Eur Arch Otorhinolaryngol (2014) 271:2835–2837 2837

123