Comparing Transcanal Endoscopic Surgery to Post-Auricular Microscopic Surgery in Pediatric Ossiculoplasty: Evaluation of Hearing Outcomes and Postoperative Pain

By June 7, 2019

Purcell, Patricia1; Cushing, Sharon1; Papsin, Blake1; James, Adrian1
1 Department of Otolaryngology – Head & Neck Surgery, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada.

This study compares postoperative hearing outcomes and postoperative pain among children who underwent pediatric ossiculoplasty with transcanal totally endoscopic ear surgery (TEES) versus post-auricular microscopic-guided surgery (PAMS).

– Study design: 
Retrospective case series
-Setting: Pediatric tertiary referral center
– Patients: 44 children who underwent ossiculoplasty with titanium total ossicular replacement prosthesis (TORP) after previous cholesteatoma surgery
– Interventions: Ossiculoplasty using TEES or PAMS

– Main outcome measures: Hearing outcome was measured by mean postoperative air-bone gap (ABG) at audiogram nearest to 1 year after surgery. Postoperative morbidity was measured by total number of opioid doses the child received during hospital stay, along with the highest documented postoperative pain score. All comparisons were made with Student’s t-test.
– Results: Postoperative hearing data was available for 41 children: 21 children had undergone TEES (preoperative ABG 41 dB) and 20 had undergone PAMS (preoperative ABG 42 db). Postoperative ABG at audiogram nearest to 1 year after surgery was 23 dB (SD=15) among children who underwent TEES and 25 dB (SD=13) among children who underwent PAMS (not significant with t-test, p=0.6). Children who underwent TEES received fewer doses of opioid medication than children who underwent PAMS, 0.8 (SD=1) versus 1.8 (SD=1.4) respectively (t-test, p=0.01) and had significantly lower mean post-operative pain score of 0.5 (SD=1.3) versus 3.5 (SD=2.6) respectively (t-test, p<0.001).
– Conclusion: Pediatric ossiculoplasty is feasible using TEES, and hearing outcomes are similar to microscopic approaches. Postoperative morbidity is significantly less, both in amount of postoperative opioid required and patient-reported postoperative pain score. These results support continued use of TEES in pediatric ear surgery.