Stapedectomy in children: causes and surgical results in 35 cases.

ABSTRACT

OBJECTIVES: To study children who had undergone stapedectomy at an age younger than 16 years to determine the causes (particularly frequency of congenital anomalies vs otosclerosis) and to analyze the functional results over the short-term, 1-year, and long-term postsurgery time course. DESIGN: Ten-year retrospective study covering 1998 to 2008. SETTING: Pediatric tertiary care centers. PATIENTS A total of 33 patients (35 ears) underwent stapes surgery from October 1998 to October 2008. MAIN OUTCOME MEASURE: Sex, age, preoperative and postoperative audiometric test results, associated anomalies, type of surgery (stapedotomy or partial stapedectomy), method of stapes surgery, and complications. RESULTS: The median age of patients at surgery was 13.4 years, ranging from 3.3 to 15.9 years. The major cause, which was found in 25 of 35 ears (71%), was nonprogressive conductive hearing loss due to congenital stapes fixation. The second most common cause, which was found in 6 of 35 ears (17%), was otosclerosis with progressive conductive or mixed hearing loss. Three ears presented posttraumatic stapes luxation (1 child aged 3.3 years at surgery). In 1 ear, the cause was osteogenesis imperfecta. Twenty-two ears were treated via the drill or laser-assisted small fenestra technique, and 13 ears were treated by a partial removal of the footplate covered by fascia. Early functional results were good, with a median postoperative air-bone gap of 9.8 dB, and 94% of the results were considered good or very good. There was no significant difference between early, 1-year, and longer-term audiometric results. CONCLUSIONS: Congenital fixation is the major indication for stapedectomy in children younger than 16 years. Functional results are good and remain stable over time.