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Updated: Jun 29, 2025
Author Spotlight: Advancing Endoscopic Ossiculoplasty – Techniques, Innovations, and Practical Guidance for Clinical Integration
Published on: January 26, 2024
Long-term outcomes following pediatric endoscopic titanium ossiculoplasty: A single-institution experience
Jasmine Leahy1, Kevin Wong1, Aparna Govindan1
1Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Endoscopic ossicular reconstruction in children shows stable, long-term audiometric improvement, comparable to microscopic surgery. Partial ossicular reconstruction prostheses (PORPs) demonstrated better long-term outcomes than total ossicular reconstruction prostheses (TORPs).
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Devices
Background:
- Endoscopic ossicular chain reconstruction (OCR) outcomes in adults are comparable to microscopic approaches.
- Limited data exists on endoscopic OCR in children due to unique anatomical and pathological considerations.
- This study evaluates short- and long-term surgical and audiometric outcomes of endoscopic OCR in pediatric patients.
Purpose of the Study:
- To investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted ossicular chain reconstruction.
- To compare short-term and long-term results in pediatric patients.
- To assess the efficacy of partial (PORP) and total ossicular reconstruction prostheses (TORP) in children.
Main Methods:
- Retrospective review of pediatric patients (<17 years) undergoing endoscopic OCR (2017-2021).
- Included primary/revision cases with PORP or TORP; excluded juvenile otosclerosis, congenital stapes fixation, or stapes prostheses.
- Primary outcomes: change in 4-frequency AC PTA and ABG; secondary outcomes: readmission, revision surgery, complications, surgery duration.
Main Results:
- 17 pediatric patients (average age 11.3 years) underwent endoscopic OCR with no intra/perioperative complications.
- Most common pathologies: congenital cholesteatoma (64%) and chronic otitis media (29.4%).
- Mean ABG improved from 36.8 dB preoperatively to 19.9 dB short-term and 19.5 dB long-term; PORPs showed better long-term ABG closure and lower AC PTAs than TORPs.
Conclusions:
- Endoscopic ossiculoplasty is a viable surgical option for children with ossicular erosion.
- Audiometric results are stable long-term, with a preference for partial ossicular reconstruction prostheses (PORPs).
- Outcomes mirror those reported for microscopic ossicular chain reconstruction.
Introduction:
Endoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR outcomes in children, who have unique considerations including a smaller transcanal corridor and variable pathology. The purpose of this study was to investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted OCR in both the short and long-term.
Methods:
Retrospective review of all children (<17 years) who underwent endoscopic OCR at one tertiary care center between 2017 and 2021. Children undergoing primary and revision endoscopic OCR with either partial (PORP) and total ossicular reconstruction prostheses (TORP) were included. Children undergoing surgery for juvenile otosclerosis or congenital stapes fixation, or any child receiving a stapes prosthesis were excluded. Primary outcome measures were post-operative change in 4 frequency (500 Hz, 1, 2, 4 KHz) air conduction pure tone average (AC PTA) and change in air-bone gap (ABG). Secondary measures included need for readmission and/or revision surgery, complication rate, and surgery duration.
Results:
Seventeen patients met inclusion criteria. Average age was 11.3 years (range, 5-17 years); 14 were male. A variety of fixed length, titanium total and partial prostheses were used. The most common prosthesis length was 2 mm (range 2-5 mm), and there were no intra- or perioperative complications. Mean long-term follow-up was 2.6 years. Most common pathology was congenital cholesteatoma (11/17, 64%), followed by chronic otitis media with tympanic membrane perforation (5/17, 29.4%), and extruded prosthesis (1/17, 5.9%). Intraoperatively, the most common finding was incus erosion (10/17, 58.8%), followed by malleus erosion (6/17, 35.3%), stapes erosion (4/17, 23.5%), and stapes absence (4/17, 23.5%). Eight children (47%) were reconstructed with PORPs, and 9 children (52.9%) were reconstructed with TORPs. Average ABG improved from 36.8 dB preoperatively to 19.9 dB postoperatively in the short-term and remained stable at 19.5 dB in the long-term. Average short-term ABG improvement was 4.2 dB for PORPs and 18 dB for TORPs. In the long-term, average ABG improved by 2.3 dB in PORPs and 13.4 dB in TORPs. PORPs had higher rates of ABG closure and lower AC PTAs than TORPs in the long-term.
Discussion:
Endoscopic ossiculoplasty is a viable option in children presenting with ossicular erosion from various causes. Audiometric improvement following endoscopic partial and total ossicular reconstruction remains stable over time, with a preference towards partial in the long-term, and mirrors published outcomes for microscopic surgery.
