Pediatric Congenital Middle Ear Anomalies: A Comparison of Endoscopic and Microscopic Surgical Techniques and Hearing Outcomes

By June 7, 2019

Suresh, Harini1; Tolisano, Anthony M2; Caloway, Christen L3; Basonbul, Razan3; Hunter, Jacob B2; Cohen, Michael3; Isaacson, Brandon2

1 University of Texas Southwestern Medical School, Dallas, TX, USA
2 Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
3 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

The present study aims to describe surgical and hearing outcomes for congenital ossicular anomalies in children undergoing endoscopic and microscopic techniques.

Study Design: Comparative cohort study
Setting: Two tertiary care centers
Patients: Consecutive pediatric patients with conductive hearing loss (CHL) and no history of cholesteatoma identified between March 2007 and May 2018.
Intervention: Endoscopic and microscopic middle ear surgery.

Main Outcome Measure: Postoperative change in air-bone gap (Δ-ABG).
Results: 33 ears (22 endoscopic and 11 microscopic) underwent middle ear surgery for congenital ossicular anomalies. The mean age was 10.5 years (range, 4–17 years) and 64% were male. Lateral chain anomalies (93%) were more common than those involving the stapes (21%). A partial or total ossicular replacement prosthesis was used most commonly for reconstruction (42%), followed by incus interposition (24%). Lateral chain mobilization was performed without ossicular reconstruction for 30% of cases. Preoperative ABG (32 vs. 35 dB, p=0.479) and Δ-ABG (3 dB [range -15 to 33] vs. 13 dB [range -9 to 34 dB], p=0.150) were similar between endoscopic and microscopic cohorts. There was only one intraoperative complication: a submillimeter dural defect encountered during malleus mobilization in the microscopic cohort. There were no cases of anacusis, facial nerve weakness, dysgeusia, or prosthesis extrusion.
Conclusion: A myriad of etiologies are responsible for CHL in children with congenital ossicular chain anomalies. Endoscopic and microscopic middle ear surgery are safe and yield similar improvements in hearing, but there is a wide range of outcomes.