title: Vestibulotomy with ossiculoplasty versus round window vibroplasty procedure in children with oval window aplasia.
abstract: OBJECTIVE
  To review the surgical procedures and outcomes in children with bilateral oval window aplasia (OWA).
  
  
  METHODS
  Retrospective cohort review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Children suffering from OWA between 1990 and 2010.
  
  
  METHODS
  Vestibulotomy with ossiculoplasty (V-OPL) or round window vibroplasty (RWV).
  
  
  METHODS
  Findings at radiology and surgery, preoperative and postoperative bone conduction (BC), air conduction (AC), and RWV-air conduction (RWV-AC) thresholds and speech discrimination scores (SDSs).
  
  
  RESULTS
  Among 23 children, 11 underwent V-OPL and 8 RWV. Four children in the V-OPL group had aborted surgery and were excluded from the study. In all the remaining 19 children, the 6-month follow-up time showed postoperative AC and SDS values significantly better than the preoperative thresholds in both groups. At the 36-month long-term follow-up, AC and SDS were stable in the RWV group but showed a significant worsening in the V-OPL children compared with the 6-month follow-up results. Preoperative versus postoperative BC values showed a significant difference between the 2 groups at 36 months; 5 of the V-OPL group underwent revision following the same surgical principles, which did not result in improved outcome.
  
  
  CONCLUSIONS
  In children with OWA, V-OPL provides modest long-term results and carries higher risks of BC degradation compared to RWV. Both procedures are technically challenging but considering the respective hearing results and morbidity of primary and revision surgery, we have abandoned the V-OPL procedure in favor of RWV. In infants and children younger than 5 years with OWA previously not considered candidates for hearing restoration, we consider RWV as the first-choice surgery. It has shown to provide significantly better hearing outcomes than traditional atresia surgery with minimal complication rate.
authors.affiliation: *ENT Department, University of Verona, Verona; and †Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Colletti
authors.forename: Marco
authors.initials: M
authors.lastname: Mandalà
authors.forename: Giacomo
authors.initials: G
authors.lastname: Colletti
authors.forename: Vittorio
authors.initials: V
authors.lastname: Colletti
mesh_terms: D002648:Child; D002675:Child, Preschool; D004429:Ear Ossicles / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement; D010046:Oval Window, Ear / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D012405:Round Window, Ear / Q000601:surgery*; D016896:Treatment Outcome