Prognostic Factors of Pediatric Revision Ossicular Chain Reconstruction

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Objective:Ossicular chain reconstruction (OCR) is a surgical method used to repair conductive hearing loss. In children, up to 40% of OCRs will require revisions. In this study, our aims were to validate improvement in hearing outcomes following revision OCR and identify prognostic factors for successful revision OCRs.Design:Retrospective review at the Children's Hospital of Pittsburgh from 2003 to 2014.Setting:Tertiary referral center.Patients:Pediatric patients undergoing multiple OCRs who had demographic, operative, and pre- and postoperative audiogram data. Patients included in our study had ≥ 2 OCR procedures to the same ear. Forty-three of 123 patients met inclusion criteria.Main Outcome Measures:Pre- and postoperative audiograms were used to compare the changes in pure-tone averages (PTA), speech recognition thresholds, and air-bone gaps following OCR surgeries.Results:Revision OCRs significantly improved PTA, speech recognition thresholds, and air-bone gaps (p values= 0.003, 0.004, 0.005, respectively) and seven patients (14%) had return of normal hearing (PTA < 25 dB). Cholesteatoma at the time of first revision was associated with additional OCR revisions (hazard ratio [HR]: 10.3; p=0.013), while patients who had canal wall down or no mastoidectomy during first OCR revision were less likely to require additional revision compared with patients who had canal wall up mastoidectomy (HR: 0.170, p = 0.041 versus canal wall down; HR: 0.242, p = 0.041 versus no mastoidectomy).Conclusions:Revision OCR(s) are an acceptable method to improve residual conductive hearing loss following primary OCR surgery in pediatric patients. Patients with cholesteatoma and canal wall up at the time of revision OCR have increased chances of requiring further revision.

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