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Stapedectomy in children
A De la Cruz1, S Angeli, W H Slattery
1Clinical Studies Department, House Ear Institute, Los Angeles, CA 90057-9927, USA.
Insights
Stapes surgery effectively corrects conductive hearing loss in children with otosclerosis and congenital stapedial fixation. Juvenile otosclerosis surgery yields excellent hearing results, while congenital fixation and revision surgeries show varied outcomes.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Surgical Audiology
Background:
- Stapes surgery is a standard treatment for adult otosclerosis-induced conductive hearing loss.
- The efficacy of stapes surgery in pediatric populations is less documented.
- Prior studies suggest comparable outcomes between children and adults undergoing stapedectomy.
Purpose of the Study:
- To evaluate the effectiveness of stapes surgery in children with conductive hearing loss.
- To compare outcomes between congenital stapedial fixation and juvenile otosclerosis.
- To identify factors influencing surgical success and complications in pediatric stapedectomy.
Main Methods:
- Retrospective review of 95 stapedectomies performed on 81 patients under 18 years old (1980-1994).
- Analysis of patient data including age of onset, family history, surgical findings, and hearing results.
- Categorization into congenital stapedial fixation and juvenile otosclerosis groups for comparative analysis.
Main Results:
- Overall hearing improvement was observed in 79% of primary and 89% of revision cases.
- Excellent hearing results (air-bone gap ≤ 10 dB) were achieved in 82% of juvenile otosclerosis cases versus 44% of congenital stapedial fixation cases.
- Poorer outcomes in congenital fixation and revision surgeries were associated with malleus and incus anomalies.
Conclusions:
- Stapes surgery is effective for conductive hearing loss in children, with juvenile otosclerosis showing superior outcomes.
- Congenital stapedial fixation and revision stapedectomies present unique challenges, often linked to anatomical abnormalities.
- This study highlights the importance of considering specific etiologies and associated anomalies when performing stapedectomy in children.
Abstract:
Stapes surgery for correction of conductive hearing loss in adults with otosclerosis is a well-established procedure. Its effectiveness in children, however, has received less scrutiny in the literature. Previous studies from our and other institutions demonstrated similar results in children and adults. Between 1980 and 1994 stapedectomies were done on 95 ears of 81 patients younger than 18 years (83 primary and 12 revisions). Data regarding age of onset, family history, associated anomalies, surgical findings, technique, hearing results, and complications were reviewed. Two groups were identified: congenital stapedial fixation and juvenile otosclerosis. Patients with congenital stapedial fixation had an earlier onset of hearing loss (3 vs 10 years, P < 0.001), a greater incidence of abnormalities of the malleus and incus (25% vs 3%, P < 0.001), and a slightly greater preoperative air-bone gap (35.2 +/- 12.9 vs 27.8 +/- 8.9, P = 0.002). Patients with otosclerosis had a greater frequency of a positive family history of deafness (53% vs 10%, P < 0.001). Overall, 79% of primary cases and 89% of revision cases had an improvement in hearing, with mean postoperative air-bone gaps of 15 dB and 22 dB, respectively. The gap did not widen significantly during the entire length of follow-up (mean 72 months). In primary cases, 59.1% obtained a postoperative air-bone gap of 10 dB or less. Eighty-two percent of children operated on for otosclerosis obtained excellent results (postoperative air-bone gap < or = 10 dB), compared with only 44% of children with congenital stapedial ankylosis (P = 0.02). In revision surgery, 29% of children obtained excellent results. Poorer results in both cases of congenital stapedial fixation and revision stapedectomy appear to be related to the greater incidence of associated anomalies of the malleus and incus. Indications, technique, complications, and considerations pertinent to childhood stapedectomy are discussed.