Juvenile otosclerosis and congenital stapes footplate fixation. A systematic review and meta-analysis of surgical outcomes and management.

OBJECTIVE: Juvenile Otosclerosis (JO) and Congenital Stapes Footplate Fixation (CSFF) are rare ossicular chain disorders seen in the paediatric population and present with conductive hearing loss. Ongoing controversy exists regarding the role of surgical intervention in JO and CSFF given the poorer hearing outcomes and complications when compared with surgical intervention for adult otosclerosis. The objective of this study is to assess the published data on the surgical outcomes of JO and CSFF in order to guide clinicians and counsel patients on the various medical options for these disease entities. METHODS: A systematic review of MEDLINE, EMBASE and Cochrane was performed with inclusion criteria of children with JO or CSFF and hearing outcomes following stapes surgery. Studies identified by the search were reviewed and assessed by two independent reviewers in line with the PRISMA guidelines. RESULTS: 464 articles were initially reviewed and 28 articles met inclusion in the systematic review and meta-analysis. A total of 810 ears (473 and 337 cases of JO and CSFF respectively) underwent stapes surgery. Average age at time of surgery for JO and CSFF was 14.3 and 10.2 years old respectively. The mean pre-operative Air-Bone-Gap (ABG) for JO and CSFF was 31.8 ± 5.2 dB and 39.4 ± 10 dB respectively. Following stapes surgery, the mean post-operative ABG for JO and CSFF was 9.6 ± 6 dB and 19.2 ± 12.5 dB respectively. Surgical success rate (defined as ABG <10 dB) was 81% for JO and 41% for CSFF. Mean ABG gain for JO and CSFF was 24.8 dB (95% CI: 18.6-33.1) and 22.6 dB (95% CI: 18.4-27.8) respectively. The reported number of dead ears was 4/473 (0.8%) for JO and 2/337 (0.6%) for CSFF. 23 cases (2.8%) reported sensorineural hearing loss (SNHL) >10 dB. CONCLUSION: CSFF was associated with poorer hearing outcomes compared to JO, however both entities showed similar improvement in ABG post operatively. Counselling patients and their families on the surgical success rates and complications of JO or CSFF is an important part of the decision making process when deciding between a surgical option or conservative measures such as hearing aids.

An unusual finding of schwannoma in the columellar area-A case report.

INTRODUCTION: Schwannomas are benign tumours of the nerve sheath that originate from Schwann cells. Less than 4% of these tumours arise in the sinonasal tract. Columellar involvement is extremely rare - three other cases involving the columella have been reported since 1967. PRESENTATION OF CASE: A 25-year-old woman presented with a swelling of the nasal columella from eight months into pregnancy. She presented with right nasal obstruction and discomfort over the nasal bridge. Pre-operative MRI and ultrasound were performed. The mass was surgically excised using an external septorhinoplasty approach giving a good cosmetic outcome. Histopathologic examination demonstrated schwannoma. DISCUSSION OF CASE: Nasal schwannoma may present with variable symptoms. We discuss the MRI and histological features of schwannoma. A literature review suggests that schwannomas may have accelerated growth in pregnancy. The open rhinoplasty approach is the favoured method for excision of schwannomas near the columellar region. CONCLUSION: Nasal schwannomas are rare in the sinonasal tract, however they need to be considered part of the differential diagnosis for nasal masses. The treatment of choice for these lesions is surgical excision.