Hearing results in pediatric patients with chronic otitis media after ossicular reconstruction with partial ossicular replacement prostheses and total ossicular replacement prostheses

Objective: To examine hearing results in pediatric patients after ossicular reconstruction with partial ossicular replacement prostheses (PORPs) and t otal ossicular replacement prostheses (TORPs) in children with chronic otit is media. Methods: A retrospective chart review was performed on 55 pediatr ic patients with chronic otitis media who underwent ossicular reconstructio n from 1991 to 1998. Patients' audiograms were evaluated preoperatively and postoperatively for pure-tone average (PTA), air-bone gap (ABG), speech re ception threshold (SRT), method of ossicular reconstruction, and management of the mastoid. Results: Twenty-seven patients underwent ossicular reconst ruction with TORPs. The average preoperative ABG was 40.1 dB, and the avera ge postoperative ABG was 31.6 dB. Forty-one percent of the children improve d their PTA greater than 10 dB postoperatively; and 52% of children did not change their ABG by more than 10 dB postoperatively. Nineteen percent of c hildren with TORPs had a postoperative ABG less than 20 dB, and 44% of chil dren with TORPs had a postoperative ABG less than 30 dB. Twenty-eight patie nts underwent ossicular reconstruction with PORPs. The average preoperative ABG was 29.7 dB, and the average postoperative ABG was 22.5 dB. Thirty-two percent of patients improved their PTA by greater than 10 dB, while 57% of children with PORPs did not change their ABG by more than 10 dB postoperat ively. Forty-three percent of children with PORPs had an ABG of less than 2 0 dB postoperatively, and 71% of children with PORPs had a postoperative AB G less than or equal to 30 dB. Conclusions: Children who underwent ossicula r reconstruction with PORPs had slightly better postoperative hearing than did children with TORPs. Postoperative hearing was essentially unchanged in approximately 55% of both groups. Preoperative hearing levels may be the m ost important factor determining postoperative hearing in nonstaged surgery for children with chronic otitis media. Long-term hearing results in child ren with single-stage surgery were not as good as those reported in the lit erature for staged surgery. Severe mucosal disease and eustachian tube dysf unction may contribute to poorer hearing results in children.