Total and partial ossiculoplasty in children: Audiological results and predictive factors

To assess ossiculoplasty results in children and screen for predictive factors of efficacy.

Seventy five children undergoing ossiculoplasty between 2001 and 2014 in a pediatric ENT department were included. The following data were collected and analyzed: demographic data, surgical indication, history of tympanoplasty, contralateral ear status (healthy, affected), preoperative hearing thresholds, surgical technique, intraoperative findings, and ossicular chain status at eardrum opening. Audiological results were reported according to American Academy of Otolaryngology-Head and Neck Surgery guidelines.

Forty eight patients were included in the total ossicular reconstruction prosthesis (TORP) group. Mean age at surgery was 9.9years. Mean follow up was 2.7years. Mean air-bone gap (ABG) closure to within 20dB was achieved in 40% of cases at medium term (12 to 18 months after surgery). Air conduction (AC) threshold ≤30dB was achieved in 68% of cases. AC threshold improved by 14.6dB and 8.7dB at medium and long-term follow-up, respectively. A significant correlation was found between success rate and absence of history of tympanoplasty. The success rate was higher for primary than for revision procedures. Twenty seven children were included in the partial ossicular reconstruction prosthesis (PORP) group. Mean age was 9.5years, and mean follow-up 2.6years. Mean air-bone gap (ABG) closure to within 20dB was achieved in 75% of cases at medium term. AC threshold ≤30dB was achieved in 75% of cases AC threshold improved by 9.3dB and 5dB at medium and long-term follow-up, respectively. No predictive factors for success were found in the PORP group.

The present study suggested that total ossiculoplasty leads to better results when performed in first-line. It also confirmed that functional outcome is better in partial than total ossicular reconstruction prosthesis.