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Pediatric stapedectomy: does cause of fixation affect outcomes?
Ryan E Neilan1, Richard W Zhang, Peter S Roland
1University of Texas Southwestern Medical Center, Department of Otolaryngology, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
Insights
Pediatric stapedectomy offers comparable hearing outcomes for congenital stapes fixation and juvenile otosclerosis. However, the risk of delayed sensorineural hearing loss is higher in children undergoing this procedure.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Surgical Outcomes
Background:
- Stapes fixation, a common cause of conductive hearing loss in children, can result from congenital anomalies or juvenile otosclerosis.
- Stapedectomy is a surgical procedure to correct hearing loss caused by stapes fixation.
Purpose of the Study:
- To compare the surgical outcomes of stapedectomy in pediatric patients with congenital stapes fixation versus juvenile otosclerosis.
- To evaluate the efficacy and safety of stapedectomy in children for different etiologies of stapes fixation.
Main Methods:
- Retrospective chart review of patients under 18 who underwent stapedectomy between 1999 and 2011.
- Data collected included age, gender, pre- and postoperative audiograms, etiology of stapes fixation, prosthesis type, and complications.
- Audiometric outcomes, specifically air-bone gap (ABG), were analyzed.
Main Results:
- Twenty-four stapedectomies were performed in 22 children (7 with juvenile otosclerosis, 17 with congenital stapes fixation).
- Overall mean postoperative ABG improved significantly (34.7 dB pre-op to 9.0 dB post-op, p<0.001).
- Postoperative ABG was similar between congenital stapes fixation (9.6 dB) and juvenile otosclerosis (7.2 dB) groups (p=0.6). Two patients experienced delayed profound sensorineural hearing loss.
Conclusions:
- Stapedectomy in children yields comparable hearing results to adults, irrespective of the cause of stapes fixation.
- The pediatric population may have a higher incidence of delayed sensorineural hearing loss following stapedectomy.
- Stapedectomy is an effective treatment for hearing loss due to stapes fixation in children.
Objective:
To compare outcomes of stapedectomy in patients with congenital stapes fixation versus juvenile otosclerosis.
Methods:
A retrospective chart review was performed from January 1, 1999 until January 1, 2011 to identify patients under 18 years old who underwent a stapedectomy. Age, gender, pre- and postoperative audiograms, intraoperative findings including etiology of stapes fixation, prosthesis type, and complications were recorded.
Results:
Twenty-two children were identified who had undergone a stapedectomy (two patients underwent sequential bilateral surgery) resulting in a total of 24 ears. The cause of fixation included juvenile otosclerosis (n=7) and congenital stapes fixation (n=17). The overall mean pre-operative air-bone gap (ABG) was 34.7 dB (SD: 13.5) compared to a postoperative mean ABG of 9.0 (SD: 9.3) (p<0.001). The mean postoperative ABG of 9.6 (SD: 10.5) in the congenital stapes fixation group was similar to the mean postoperative ABG of 7.2dB (SD: 5.4) in children with juvenile otosclerosis (p=0.6). Two patients developed delayed profound sensorineural hearing loss approximately two weeks after surgery. One patient with profound sensorineural hearing loss recovered to a profound mixed hearing loss with a speech discrimination score of 80%.
Conclusions:
Pediatric stapedectomy has comparable results to stapedectomy in adults regardless of the cause of stapes fixation; however, delayed sensorineural hearing loss may be higher in the pediatric population.
