title: Total ossiculoplasty in children: predictive factors and long-term follow-up.
abstract: OBJECTIVE
  To evaluate the long-term results and predictive factors of a good outcome with the use of a total ossicular replacement prosthesis in children.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  The study included 114 children (116 ears).
  
  
  METHODS
  A total of 116 ears underwent total ossicular chain reconstruction with a titanium prosthesis. Cartilage was always used for tympanic membrane reconstruction.
  
  
  METHODS
  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 χ(2) 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. Only 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.
authors.affiliation: Service d'Oto-Rhino-Laryngologie Pédiatrique et de Chirurgie Cervico-Faciale, Hôpital d'Enfants Armand-Trousseau, University Pierre et Marie Curie, University Paris 6, 26 Ave du Dr Arnold Netter, Paris, France. jerome.nevoux@trs.aphp.fr
authors.forename: Jerome
authors.initials: J
authors.lastname: Nevoux
authors.forename: Antoine
authors.initials: A
authors.lastname: Moya-Plana
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvin
authors.forename: Francoise
authors.initials: F
authors.lastname: Denoyelle
authors.forename: Erea-Noel
authors.initials: EN
authors.lastname: Garabedian
mesh_terms: D000293:Adolescent; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D001844:Bone Conduction; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006314:Hearing Loss, Conductive / Q000209:etiology*; D006801:Humans; D008297:Male; D009998:Ossicular Prosthesis; D010033:Otitis Media / Q000175:diagnosis / Q000601:surgery; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D014025:Titanium; D014057:Tomography, X-Ray Computed
chemical_list: D014025:Titanium