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Primary stapedotomy in children with otosclerosis: A prospective study of 41 consecutive cases
Robert Vincent1, Inge Wegner2,3, Bernard M D Vonck2,3
1Jean Causse Ear Clinic, Traverse de Béziers, Colombiers, France.
Insights
Primary stapedotomy effectively restores hearing in children with juvenile otosclerosis, with 93% achieving significant air-bone gap closure. This surgical intervention is a safe and feasible option for pediatric patients.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Audiology
Background:
- Otosclerosis, a condition causing stapes fixation, can affect children, leading to hearing loss.
- Surgical management of otosclerosis in pediatric populations is less extensively studied than in adults.
Purpose of the Study:
- To prospectively evaluate hearing outcomes in children with otosclerosis after primary stapes surgery.
- To assess the safety and feasibility of primary stapedotomy in pediatric patients.
Main Methods:
- A prospective case series included 34 pediatric patients (41 ears) undergoing primary stapedotomy for otosclerosis.
- Hearing was assessed using pure-tone audiometry pre- and post-operatively, measuring air-conduction thresholds, bone-conduction thresholds, and air-bone gaps.
- Follow-up audiometry was conducted at multiple intervals up to 24 months and annually thereafter.
Main Results:
- Excellent air-bone gap closure was achieved: ≤10 dB in 93% and ≤20 dB in 98% of cases.
- Mean air-conduction threshold gain was 23 dB, with a mean air-bone gap closure of 23 dB.
- One case (2.4%) experienced a mild sensorineural hearing loss (>10 dB change in bone-conduction thresholds).
Conclusions:
- Primary stapedotomy is a safe and effective treatment for hearing loss in children with juvenile otosclerosis.
- The procedure demonstrates favorable hearing outcomes and a low risk of complications in this pediatric cohort.
Objectives/Hypothesis:
To prospectively evaluate hearing outcomes in children with otosclerosis undergoing primary stapes surgery.
Study Design:
A nonrandomized, nonblinded, prospective case series.
Methods:
Thirty-four consecutive pediatric patients who underwent 41 primary stapedotomies for otosclerosis in a tertiary referral center were included. Patients were included when there was evidence of otosclerotic stapes fixation and they had available postoperative pure-tone audiometry. Patients underwent primary stapedotomy with vein graft interposition and reconstruction with a regular piston, bucket handle prosthesis, or total ossicular replacement prosthesis. Hearing results were evaluated using pre- and postoperative four-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gaps were measured. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter.
Results:
Overall, a postoperative air-bone gap closure of 10 dB or less was achieved in 93% of cases and to within 20 dB in 98% of cases. Mean gain in air-conduction threshold was 23 dB for the entire case series, and mean air-bone gap closure was 23 dB. Postoperative sensorineural hearing loss, defined as changes in bone-conduction thresholds exceeding 10 dB, occurred in one case at last follow-up. The bone-conduction threshold deteriorated 13 dB in this case.
Conclusion:
Primary stapedotomy is a safe and feasible treatment option in children with juvenile otosclerosis.
Level Of Evidence:
4.
