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Long term results of total ossiculoplasty in pediatric cholesteatoma surgery

Presenting Author: Francoise Denoyelle

Published online by Cambridge University Press:  03 June 2016

Francoise Denoyelle ,
Jerome Nevoux ,
Pierre Chauvin  and
Noël Garabédian
Francoise Denoyelle
Affiliation:
Necker Children's Hospital, APHP and Paris Descartes University, Paris France
Jerome Nevoux
Affiliation:
Hopitel de Bicêtre et Université Paris XI
Pierre Chauvin
Affiliation:
Department of Public Health, Saint Antoine Hospital ans Paris VI University
Noël Garabédian
Affiliation:
Necker Children's Hospital, APHP and Paris Descartes University, Paris France
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Abstract

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Learning Objectives: To evaluate the long-term results and predictive factors of a good outcome with the use of a total ossicular replacement prosthesis in pediatric cholesteatoma surgery.

Objective: To evaluate the long-term results and predictive factors of a good outcome with the use of a total ossicular replacement prosthesis in pediatric cholesteatoma surgery.

Design and setting: Retrospective case review in a tertiary referral center.

Patients: The study included 114 children (116 ears).

Interventions: A total of 116 ears underwent total ossicular chain reconstruction with a titanium prosthesis. Cartilage was always used for tympanic membrane reconstruction.

Main Outcome Measures: Audiological results were evaluated according to the guidelines of the American Academy of Otolaryngology–Head and Neck Surgery. Predictive factors of audiological results were determined. Logistic regression and X2 tests were used for statistical analysis.

Results: The mean age at surgery was 9.8 years. Ossiculoplasty was performed during second-look surgery in 91 ears (78.4%) and during another stage in 25 ears (21.6%). The first-stage procedure was always performed for cholesteatoma. Audiometric results were available for 116 ears at 1 year, for 89 ears (76.7%) at 2 years, and for 42 ears (36.2%) at 5 years. Closure of the average air-bone gap (ABG) to within 20 dB was achieved in 65 ears (56%) at 1 year. The mean (SD) preoperative and postoperative (at 1 year) ABGs were 41.0 (9.5) dB and 22.4 (12.6) dB, respectively. There were no cases of extrusion, but 17 luxations of the prosthesis were confirmed by computed tomography. Luxation occurred on average at 31.4 months. Three 4000-Hz degradations of bone conduction were reported, with no dead ears. We examined 3 predictive factors of auditory results: preoperative ABG, footplate status, and postoperative otoscopic findings.

Conclusions: Total ossiculoplasty is a reliable technique in children. Long-term hearing outcomes are stable and satisfactory, but luxation can occur at any time. Preoperative ABG and footplate status are negative predictive factors of auditory results.