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Congenital conductive hearing loss
Eyal Raveh1, Weili Hu, Blake Croll Papsin
1Departments of Otolaryngology, The Hospital for Sick Children, Toronto, Canada. eraveh@netvision.net.il
Insights
Exploratory tympanotomy for congenital conductive hearing loss showed mixed results. Surgical reconstruction offered significant benefit in less than half of patients, particularly those with mobile stapes.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Hearing Loss Research
Background:
- Congenital conductive hearing loss often results from ossicular deformities.
- Treatment options include hearing aids or surgical reconstruction.
- Exploratory tympanotomy is a diagnostic surgical procedure.
Purpose of the Study:
- To evaluate the outcomes of exploratory tympanotomy for congenital conductive hearing loss in pediatric patients.
- To assess the efficacy of surgical reconstruction based on ossicular pathology.
- To inform surgical decision-making for congenital hearing loss.
Main Methods:
- Retrospective analysis of 67 pediatric patients undergoing exploratory tympanotomy.
- Categorization of patients based on ossicular malformation and stapes mobility (mobile vs. fixed).
- Evaluation of post-operative air-bone gap (ABG) as a measure of surgical benefit.
Main Results:
- 47% of reconstructed patients had post-operative ABG > 30 dB, indicating no significant benefit.
- Patients with mobile stapes had a 64% success rate (ABG within 30 dB) versus 33% for fixed stapes.
- Surgical correction was not performed in 39% of cases due to intraoperative findings.
Conclusions:
- Exploratory tympanotomy is a valuable diagnostic tool but may not always lead to successful surgical reconstruction.
- Stapes mobility is a critical factor influencing surgical outcomes in congenital conductive hearing loss.
- A realistic and informed approach to surgical exploration is recommended for pediatric ossicular deformities.
Abstract:
Congenital conductive hearing loss due to ossicular deformities can be treated by either rehabilitation with a hearing aid or surgical reconstruction. We present the results of exploratory tympanotomy performed in a large paediatric otolaryngology centre in 67 patients with non-serous congenital conductive hearing loss. Forty-two children had malformation of one or more ossicles without fixation of the stapes, and 19 had fixed stapes. In 26 cases, the surgeon decided not to perform surgical correction. Seven operated patients were lost to follow-up. As a group, 47 per cent of the patients who underwent reconstruction showed no significant benefit from surgery, with post-operative air-bone gaps (ABG) greater than 30 dB. Assessment of the results by pathology showed that 64 per cent of the patients with mobile stapes had an air-bone gap within 30 dB compared to only 33 per cent of the patients with fixed stapes. One patient sustained severe sensorineural loss after the procedure. Considering that exploratory tympanotomy is a relatively minimal, benign procedure but that findings during exploration may exclude the option of reconstruction (in 39 per cent of our patients), we suggest exploring the ear, but in a more realistic, informed way.