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Pediatric Ossiculoplasty

Pediatric Ossiculoplasty. Should I or Shouldn’t I?. Introduction. pediatric CHL incidence /impact specific entities tympanoplasty ossiculoplasty. Pediatric Ossiculoplasty:. pediatric ossiculoplasty differs from adult: etiology growth importance of audition

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Pediatric Ossiculoplasty

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  1. Pediatric Ossiculoplasty Should I or Shouldn’t I?

  2. Introduction • pediatric CHL • incidence /impact • specific entities • tympanoplasty • ossiculoplasty

  3. Pediatric Ossiculoplasty: • pediatric ossiculoplasty differs from adult: • etiology • growth • importance of audition • surgical results are variable • experiential data

  4. Failures • poor technical results • hearing deterioration • complications • disease recurrence • extrusion

  5. Top Ten Tips for Ossiculoplasty 1. clean/stable middle ear 2. intact tympanic membrane 3. autologous>prosthetic 4. bank incus functionally 5. stapes key to success 6. cartilage grafts 7. titanium>others 8. cartilage shoe 9. trauma does best 10. caution with stapes surgery

  6. 1. Clean and Stable Ear • avoid prosthetic reconstruction • 1° cholesteatoma resection • incus*

  7. through puberty through puberty clean not clean not through puberty surgical revision clean and through puberty clean but not through puberty not clean surgical revision Approach to Ossiculoplasty in Children After Cholesteatoma Clean, Aerated Middle Ear Space 2nd look after 1 year 2nd look after 1.5 years ossiculoplasty CT scan after 1.5 years ossiculoplasty wait until puberty ossiculoplasty

  8. 2. Intact Tympanic Membrane • best results require tension • extrusion • exceptions • distant TM repair • in-line malleus

  9. 2. Intact Tympanic Membrane • best results require tension • extrusion • exceptions • distant TM repair • in-line malleus

  10. 3. Autologous > Prosthetic • obvious • cost • incorporation • growth • downside • can harbour disease • too short

  11. 3. Autologous > Prosthetic AJ got a graph of Incus interposition vs cartilage • cartilage alone • to stapes • even without ossicles • sets up for reconstruction • maintains space

  12. 4. “Functionally” Bank Incus • put it where you’ll find it • sometimes it works! • can find it with minimal exposure

  13. 5. Stapes = Success malleus incus s • intact stapes • good hearing result • PORP • myringostapediopexy

  14. 6. Cartilage Grafts • tragal or conchal • reduce/eliminate extrusion • prevent atelectasis?

  15. 7. Titanium > Others lighter fitted length inert robust tiny

  16. Kurz Ossiculoplasty

  17. Kurz Ossiculoplasty

  18. Ossiculoplasty Results * * ABG dB HL AC PTA * p<0.05 Post-operative Pre-operative Post-operative 6 week 12 months

  19. Ossiculoplasty Results n = 43 n = 7 long term audiometric results

  20. 8. Cartilage Shoe • stabilizes the ossicle in position • works with autologous bone! • designed for titanium implant

  21. 9. Trauma Does Best wait for resolution of transient CHL explore within 6 months don’t fear removing and repositioning incus (see # 5 Stapes = Success)

  22. 10. Careful With the Stapes basal turn of cochlea vestibule oval window • fixed footplate • congenital • middle ear sclerosis

  23. 10. Careful With the Stapes • fixed footplate • congenital • middle ear sclerosis

  24. Conclusions • consider the top ten points in decisions making about pediatric ossculoplasty • results are operator dependent • variable • possibly not durable • difficult to predict

  25. Conclusion • conductive hearing loss in children • breadth of pediatric otology • rapidly changing field • decision making central to obtaining successful outcomes

  26. Conclusions • understand patient’s: • needs • expectations • anatomy • physiology • each ear is different

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