Muñoz-Hernández DE, Arrieta-Vázquez EV, Amayo-Ramírez R, Flores-Montoya J, Cisneros-Lesser JC

Language: Spanish
References: 11
Page: 109-115
PDF size: 159.03 Kb.

ABSTRACT

The diagnosis of a uni- or bilateral conductive hearing loss can have congenital, infectious, neoplastic and traumatic causes. The most common causes are otosclerosis and congenital stapes fixation; both of them are similar in clinic and audiometric characteristics. In some cases the intraoperative findings determine the presence of a congenital ossicular anomaly which needs a different surgical treatment. Objective: To describe five cases of congenital ossicular malformation that were intraoperative findings during exploratory tympanotomy of patients with conductive hearing loss. Material and methods: In this observational, descriptive and retrospective study, we describe the morphologic characteristics of patients with congenital ossicular malformation who were submitted to an exploratory tympanotomy with initial diagnosis of conductive hearing loss, as well as their audiometric and tomographic characteristics and an analysis of postsurgical results based on the pure tone average. Results: Five patients were surgically treated, three male and two female, with an age average of 12. In three cases the hearing loss was unilateral and two were bilateral. There were six exploratory tympanotomies in total. The surgical treatment consisted in stapes surgery in three ears, ossiculoplasty with autologous incus interposition in two ears and one stayed without surgical resolution. The preoperative mean of PTA was 71.5 dB (SR 15.51) and postoperative 33.25 dB (SR 16.22), with an audiometric success in four cases. Of the five ears surgically treated, three reached a PTA of normal hearing and all of them increased their values in the speech audiometry. Conclusions: Some of the audiometric characteristics that made the suspicious diagnosis of congenital ossicular malformation are the presence of a wide air-bone gap and the absence of the Carhart notch. The surgical management of the ossicular chain has to be individualized.

REFERENCES

1. Briggs RJ, Luxford WM. Correction of conductive hearing loss in children. Otolaryngol Clin North Am. 1994; 27 (3): 607-620.

2. Thomeer HG, Kunst HP, Cremers CW. Congenital stapes ankylosis associated with another ossicular chain anomaly-surgical results in 30 ears. Arch Otolaryngology Head Neck Surg. 2011; 137 (9): 935-941.

3. Cousins VC, Milton CM. Congenital ossicular abnormalities. A review of 68 cases. Am J Otol. 1998; 9 (1): 76-80.

4. Tabb HG. Symposium: Congenital anomalies of the middle ear. I. Epitympanic fixation ofincus and malleus. Laryngoscope. 1976; 86 (2): 243-246.

5. Thomeer HG, Kunst HP, Cremers CW. Isolated congenital stapes ankylosis: surgical results in a consecutive series of 39 ears. Ann Otol Rhinol Laryngol. 2010; 119 (11): 761-766.

6. Teunissen E, Cremers CW. Surgery for congenital anomalies of the middle ear with mobile stapes. Eur Arch Otorhinolaryngol. 1993; 250 (6): 327-331.

7. Roman S, Nicollas R, Triglia JM. Practice guidelines for bone-anchored hearing aids in children. Eur Ann Otorhinolaryngol Head Neck Dis. 2011; 128 (5): 253-258.

8. Schwager K. Reconstruction of middle ear malformations. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2007; 6: Doc 01.

9. Stevenson DS, Proops DW, Wake MJ et al. Osseointegrated implants in the management of childhood ear abnormalities: the initial Birmingham experience. J Laryngol Otol. 1993; 107 (6): 502-509.

10. Funasaka S. Congenital ossicular anomalies without malformations of the external ear. Arch Otorhinolaryngol. 1979; 224 (3-4): 231-240.

11. Hough JVD. Malformations and anatomical variations seen in the middle ear during the operation for mobilisation of the stapes. Laryngoscope. 1958; 68: 1337-1379.