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The Microscopic Transcanal Approach in Stapes Surgery Revisited
Published on: February 16, 2022
Predictive factors in pediatric stapedectomy
D Bradley Welling1, James A Merrell, Meredith Merz
1Department of Otolaryngology, The Ohio State University, Columbus, USA. Welling.1@osu.edu
Insights
Pediatric stapedectomy outcomes vary by diagnosis. Tympanosclerosis fixation yields poorer hearing results compared to congenital or otosclerosis fixation in children undergoing stapes surgery.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Audiology
Background:
- Stapedectomy is a surgical procedure to improve hearing in cases of stapes fixation.
- Understanding factors influencing postoperative hearing outcomes in pediatric stapedectomy is crucial for patient management.
- Previous studies have primarily focused on adult populations, necessitating specific research on pediatric outcomes.
Purpose of the Study:
- To identify predictive factors for postoperative hearing results in pediatric stapedectomy.
- To compare hearing outcomes based on the underlying diagnosis causing stapes fixation in children.
Main Methods:
- Retrospective case series analysis of 66 pediatric stapedectomies (age ≤ 17 years).
- Evaluation of factors including age, diagnosis (tympanosclerosis, otosclerosis, congenital fixation), graft/prosthesis type, ossicular abnormalities, and revision surgery.
- Outcomes assessed using American Academy of Otolaryngology-Head and Neck Surgery guidelines.
Main Results:
- Poorer mean postoperative air-bone gap (24.9 dB) in tympanosclerotic footplate fixation compared to congenital (15.7 dB) or otosclerosis (13.1 dB) fixation (P=.024).
- Revision stapedectomy was linked to inferior hearing outcomes.
- Patient age, graft type, and prosthesis type did not significantly impact hearing results.
Conclusions:
- Pediatric stapedectomy for tympanosclerosis-related stapes fixation results in less favorable hearing outcomes than for congenital or otosclerosis fixation.
- Hearing outcomes for congenital and otosclerosis fixation in children align with those reported in adult series.
- Diagnosis is a key determinant of stapedectomy success in pediatric patients.
Objective/Hypothesis:
The objective of the study was to investigate predictive factors in the postoperative hearing outcomes in pediatric stapedectomy.
Study Design:
Retrospective case series. The study was performed in a tertiary academic otological practice.
Methods:
The outcome of 66 stapedectomies in children 17 years of age and younger were analyzed according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium guidelines. Factors evaluated included patient age, underlying diagnosis (tympanosclerosis, otosclerosis, congenital fixation), type of footplate graft and type of prosthesis used, associated ossicular abnormalities, and revision surgery.
Results:
The mean postoperative air-bone gap following stapedectomy in children with tympanosclerotic footplate fixation (24.9 dB [+/-11 dB]) was significantly worse than in patients with an underlying diagnosis of congenital stapes fixation (15.7 dB [+/-9 dB]) or otosclerosis (13.1 dB [+/-3 dB]) (P =.024). Revision stapedectomy was also associated with a poorer outcome, but patient age and prosthesis and graft type did not contribute to the outcome in a statistically significant manner.
Conclusions:
Pediatric patients with stapes fixation resulting from tympanosclerosis showed poorer outcomes from stapedectomy than patients with congenital or otosclerotic fixation. Outcomes for congenital or otosclerosis fixation more nearly matched the outcomes in the literature for adult series.
