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Daniel A, Budiono G, Rao A, Low GK, Ellis MP, Lee J. Juvenile otosclerosis and congenital stapes footplate fixation. A systematic review and meta-analysis of surgical outcomes and management. Int J Pediatr Otorhinolaryngol 2023; 166:111418. [PMID: 36709714 DOI: 10.1016/j.ijporl.2022.111418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/28/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- Andrew Daniel
- Department of Otolaryngology, Head and Neck Surgery, Nepean Hospital, NSW, Australia.
| | - Gideon Budiono
- Department of Otolaryngology, Head and Neck Surgery, Nepean Hospital, NSW, Australia
| | - Amshuman Rao
- Department of Otolaryngology, Head and Neck Surgery, Nepean Hospital, NSW, Australia
| | - Gary Kk Low
- Research Operations, Nepean Hospital, Nepean Blue Mountain Local Health District, Derby St, Kingswood, NSW, 2750, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Matthew Peter Ellis
- Department of Otolaryngology, Head and Neck Surgery, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom; Glasgow Medical School, Glasgow University, Glasgow, United Kingdom
| | - Jennifer Lee
- Department of Otolaryngology, Head and Neck Surgery, Nepean Hospital, NSW, Australia; Department of Otolaryngology, Head and Neck Surgery, The Children's Hospital in Westmead, NSW, Australia
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Management of Juvenile Otosclerosis: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111787. [PMID: 36421236 PMCID: PMC9688878 DOI: 10.3390/children9111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
Background. Otosclerosis can occur during childhood, resulting in the early onset of conductive hearing loss. The approach to a child with otosclerosis can present some difficulties in terms of diagnosis and treatment, and the literature on juvenile otosclerosis (JO) is still relatively limited. Aim. To explore the current approaches to JO, in order to clear the management of this condition and evaluate the outcomes and the possible complications of surgical treatment. Methods. A systematic review was performed according to PRISMA guidelines, searching Medline and Embase from January 2002 through to 30 September 2022. A total of 759 papers were identified but based on specified criteria, nine were included in this study. Results. There were 94 children affected by JO and treated by stapes surgery. According to the available data, Male: Female ratio was 1:3−4, whilst the mean ages ranged from 10 to 16.3 years at the time of stapes surgery. After stapes surgery, the target of ABG < 10 dB was achieved in most of the patients. Overall, the 4 complications were reported (4/94= 4%): stenosis of the external ear canal, deterioration of hearing, anacusis with vertigo, tinnitus. Conclusions. The heterogeneity of the available studies does not allow us to draw straight conclusions on this topic, currently. More data about the natural history of the disease in children could help in approaching the treatment correctly, and possibly in drawing guidelines. Studies with a prolonged follow-up could be helpful for assisting clinicians and families in taking the most favorable decision about treatment.
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Kang BC, Ku JY, Ahn JH, Park HJ, Chung JW. Hearing Outcomes of Stapes Surgery in Children With Stapes Fixation and Ossicular Anomalies. Otol Neurotol 2021; 42:1039-1043. [PMID: 33710147 DOI: 10.1097/mao.0000000000003117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate hearing outcomes after stapes surgery in children with stapes fixation. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS Forty-nine patients (66 ears) aged less than 15 years who received stapes surgery. INTERVENTIONS Stapes surgery. MAIN OUTCOMES AND MEASURES Preoperative symptoms, bilateral involvement, pure-tone hearing levels, and perioperative complications were analyzed using paired t test and Mann-Whitney U test. RESULTS The chief complaint of all patients was hearing disturbance. Sixteen ears were diagnosed with stapes fixation and an additional congenital ossicular anomaly and 50 ears had only stapes fixation. Preoperative mean bone conduction and air conduction thresholds were 12.0 ± 5.8 dB and 60.9 ± 10.9 dB, respectively. The mean air-bone gap (ABG) was 48.9 ± 12.0 dB in patients with stapes fixation and an ossicular anomaly. The postoperative mean ABG was 23.6 ± 14.5 dB, and the ABG closure was 25.3 ± 18.2 dB. In patients with stapes fixation only, the preoperative mean bone conduction and air conduction thresholds were 14.3 ± 7.5 dB and 49.6 ± 9.5 dB, respectively, and the mean ABG was 35.5 ± 9.6 dB. The postoperative mean ABG was 14.4 ± 10.3 dB, and the ABG closure was 16.2 ± 16.1 dB. The successful results (ABG <20 dB) were 75.8% overall, 56.3% for fixation and an ossicular anomaly, and 82.0% for fixation only. CONCLUSIONS In children with stapes fixation, hearing loss was worse when the fixation was combined with an ossicular anomaly. Ossicular continuity, especially of the incus, is the most important factor for successful stapes surgery. Appropriate diagnosis and surgical intervention can lead to good results for children with stapes fixation.
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Affiliation(s)
- Byung Chul Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Ja Yoon Ku
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joong Ho Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Miller KA, Fina M, Lee DJ. Principles of Pediatric Endoscopic Ear Surgery. Otolaryngol Clin North Am 2019; 52:825-845. [DOI: 10.1016/j.otc.2019.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tolisano AM, Fontenot MR, Nassiri AM, Hunter JB, Kutz JW, Rivas A, Isaacson B. Pediatric Stapes Surgery: Hearing and Surgical Outcomes in Endoscopic vs Microscopic Approaches. Otolaryngol Head Neck Surg 2019; 161:150-156. [DOI: 10.1177/0194599819836679] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To compare endoscopic and microscopic pediatric stapes surgery. Study Design Case series with chart review. Setting Two academic otology practices. Subjects and Methods Surgical and hearing outcomes were compared for consecutive children (<18 years) undergoing microscopic and endoscopic stapes surgery. The main outcome measure was closure of the air-bone gap (ABG) to ≤20 dB. Results Twenty-two endoscopic surgeries (17 stapedectomies, 4 stapedotomies, and 1 stapes mobilization) and 52 microscopic surgeries (30 stapedectomies, 19 stapedotomies, and 3 stapes mobilizations) were performed. Patient demographics, history of ipsilateral middle ear surgery, and revision stapes surgery status were similar. The most common diagnosis for the endoscopic group and microscopic group were congenital stapes footplate fixation (45.5%) and juvenile otosclerosis (46.2%), respectively. Preoperative ABGs in the endoscopic (37.7 dB) and microscopic (32.8 dB) groups ( P = .170) were similar. There were no major complications, including facial nerve injury or anacusis, in the endoscopic group. Postoperative sensorineural hearing loss (>15 dB) did not occur in any patients in the endoscopic group but was present in 2 patients in the microscopic group ( P = .546). Improvement in pure-tone average (25.9 dB vs 18.5 dB, P = .382) and ABG (21.7 dB vs 14.7 dB, P = .181) was similar, and postoperatively, the median ABG was 11.3 dB and 15.0 dB for endoscopic and microscopic cases ( P = .703), respectively. ABG closure to ≤20 dB (72.7% vs 65.2%, P = .591) was also similar. Conclusion Pediatric endoscopic stapes surgery is safe and hearing outcomes are similar to the microscopic approach when performed by experienced endoscopic ear surgeons.
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Affiliation(s)
- Anthony M. Tolisano
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Miles R. Fontenot
- Medical Scientist Training Program, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley M. Nassiri
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacob B. Hunter
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joe Walter Kutz
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alejandro Rivas
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brandon Isaacson
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Transcanal Endoscopic Ear Surgery for the Management of Congenital Ossicular Fixation. Otol Neurotol 2016; 37:1071-6. [DOI: 10.1097/mao.0000000000001154] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Markou K, Stavrakas M, Karkos P, Psillas G. Juvenile otosclerosis: a case presentation and review of the literature. BMJ Case Rep 2016; 2016:10.1136/bcr-2015-214232. [PMID: 27084899 DOI: 10.1136/bcr-2015-214232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Otosclerosis in childhood and adolescence or juvenile otosclerosis is a rare disorder resulting in conductive hearing loss. A 9-year-old boy presented to our clinic, suffering from moderate hearing loss. According to his parents, his hearing acuity had progressively deteriorated over the past 2 years. Otoscopy and tympanometry revealed bilateral secretory otitis media and the patient underwent bilateral grommet insertion. However, he continued to report of hearing loss and a right exploratory tympanotomy was performed. Stapedial fixation was confirmed, being compatible with juvenile otosclerosis, and we proceeded to a right stapedotomy. One year later, follow-up showed satisfactory outcome with an air-bone gap closure to 10 dB. Juvenile otosclerosis with the coexistence of persistent secretory otitis media can be overlooked. Affected children from 9 years of age are strongly motivated to undergo stapes surgery for juvenile otosclerosis, following parental consent.
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Affiliation(s)
| | - Marios Stavrakas
- 1st ENT Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Karkos
- 1st ENT Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Georgios Psillas
- 1st ENT Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Yellon RF, Thottam PJ. When should stapes surgery be performed in children? Laryngoscope 2015; 125:2631-2. [DOI: 10.1002/lary.25235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Robert F. Yellon
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh; Pittsburgh Pennsylvania
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
| | - Prasad J. Thottam
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh; Pittsburgh Pennsylvania
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
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Primary stapedotomy in children with otosclerosis: A prospective study of 41 consecutive cases. Laryngoscope 2015; 126:442-6. [DOI: 10.1002/lary.25403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 11/07/2022]
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Asik B, Binar M, Serdar M, Satar B. A meta-analysis of surgical success rates in congenital stapes fixation and juvenile otosclerosis. Laryngoscope 2015; 126:191-8. [PMID: 25963343 DOI: 10.1002/lary.25368] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess published reports in the literature on surgical success rates in patients with congenital stapes fixation (CSF) and juvenile otosclerosis (JO). DESIGN Systematic review of the literature and meta-analysis of published data. DATA SOURCES PubMed, SAGE, MEDLINE, and Cochrane. REVIEW METHODS A literature search was performed and evaluated based on established criteria. Two independent reviewers (b.a., m.b.) inspected titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis. An air-bone gap (ABG) of 0 to 10 dB hearing level was described as success of surgery. RESULTS A random effects model was used to analyze the data. A total of 27 studies were included in the meta-analysis, whereas 934 were excluded. The total number of operated ears was 445 (256 ears with JO and 189 ears with CSF). At the time of surgery, the age of the patients ranged from 3 to 18 years. The success rate was 80.2% for JO and 54% for CSF. The overall success rate was 69.9%. The rate of postoperative sensorineural hearing loss was 3.4% for JO and 2.1% for CSF. CONCLUSIONS Overall, stapes surgery in children with JO or CSF has a moderate success rate (69.9%) to provide ABG closure of 10 dB. The success rate for CSF in the setting of ossicular abnormalities is 54%. This meta-analysis suggests that if JO can be determined before surgery, a higher success rate is possible (80.2%).
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Affiliation(s)
- Burak Asik
- Department of Otolaryngology-Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Murat Binar
- Department of Otolaryngology-Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Muhittin Serdar
- Department of Medical Biochemistery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Bulent Satar
- Department of Otolaryngology-Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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