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Factors influencing hearing outcomes in pediatric patients undergoing ossicular chain reconstruction
Nandini Govil1, Thomas M Kaffenberger2, Amber D Shaffer3
1Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Suite 519, 203 Lothrop St, Pittsburgh, PA 15213, USA.
Insights
Titanium prostheses and partial ossicular replacement prostheses (PORP) improved hearing outcomes in pediatric ossicular chain reconstruction (OCR). These findings offer valuable insights for optimizing surgical success in children with conductive hearing loss.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Conductive hearing loss in children often results from ossicular chain disruption.
- Pediatric ossicular chain reconstruction (OCR) outcomes are influenced by various factors, yet research remains limited.
- Understanding these factors is crucial for improving surgical success rates in pediatric patients.
Purpose of the Study:
- To identify demographic and surgical factors impacting hearing outcomes in pediatric ossicular chain reconstruction (OCR).
- To evaluate the effectiveness of different prosthesis materials and types in pediatric OCR.
- To analyze factors influencing revision rates in pediatric OCR.
Main Methods:
- Retrospective chart review of 120 pediatric patients (under 18) undergoing OCR between 2003 and 2014.
- Inclusion criteria: CPT codes for OCR, available pre- and post-operative audiograms.
- Data collected: demographic information, surgical details, pure-tone averages (PTA), speech reception thresholds (SRT), and air-bone gaps (ABG).
Main Results:
- 35.8% of cases required revision, primarily due to prosthesis displacement.
- 28.5% of surgeries achieved normal post-operative hearing (PTA ≤25 dB).
- Partial ossicular replacement prostheses (PORP) showed significantly better post-operative SRT and ABG compared to total ossicular replacement prostheses (TORP).
- Titanium prostheses yielded superior post-operative PTA and greater PTA changes versus other materials.
Conclusions:
- Titanium prostheses are associated with better hearing outcomes in pediatric OCR compared to other materials.
- Partial ossicular replacement prostheses (PORP) demonstrate superior results over total ossicular replacement prostheses (TORP) in pediatric patients.
- These findings guide the selection of materials and prosthesis types to optimize hearing restoration in children.
Objective:
Ossicular chain disruption in children leads to conductive hearing loss. Few studies have focused on factors influencing successful results in pediatric ossicular chain reconstruction (OCR). We aim to determine whether demographic or surgical factors affect hearing outcomes in pediatric OCR.
Methods:
We conducted a retrospective chart review of 120 patients undergoing OCR at our institution, a tertiary care hospital, between 2003 and 2014, with median length of follow-up of 2.2 years (range 0.1-9.3 years). Pediatric patients (<18 years old at time of surgical procedure) who had current procedural terminology (CPT) codes of OCR, and available pre- and post-operative audiograms were included in the study. Demographic information, surgical details, and pre- and post-operative pure-tone averages (PTA), speech reception thresholds (SRT), and air-bone gaps (ABG) were recorded from clinic notes, audiograms and operative reports. Differences between PTA, SRT and ABG pre- and post-operatively, as well as demographic and surgical factors, were evaluated using Wilcoxon rank-sum tests. Factors influencing revision were evaluated using Log-rank tests.
Results:
A total of 120 patients (123 ears) were included. 35.8% of cases were revised, most commonly due to displaced prostheses. 28.5% of surgeries resulted in normal hearing (PTA ≤25 dB) post-operatively. Post-operative SRT and ABG were significantly better in patients with partial ossicular replacement prosthesis (PORP) compared with those with total ossicular replacement prosthesis (TORP) (p = 0.016, 0.027). Titanium prostheses resulted in better post-operative PTA and larger changes in PTA compared with all other materials (p = 0.034, p = 0.038).
Conclusions:
In our experience, children with titanium prostheses had better hearing outcomes than those with other materials, and children with PORP had better hearing outcomes than those with TORP.
