Endoscopic partial and total ossicular chain reconstruction in children: A multicentric study

Objective: To evaluate the surgical techniques and audiological outcomes from a cohort of pediatric endoscopic ossiculoplasty (OPL) procedures across three European tertiary referral centers. Methods: A retrospective, multicentric study was conducted on pediatric patients undergoing endoscopic OPL. Audiological assessments conducted before and after surgery were compared, with postoperative evaluations performed at three months post-operatively and, when available, at the last follow-up (FU) visit. Results: A total of 77 patients with a mean age of 11.36 years (range 4–17) were included, with the most frequent indication for OPL being cholesteatoma (62 %). 21 % required a combined approach with canal wall-up mastoidectomy, while OPL was performed endoscopically in all cases (Cohen 2b). Partial ossicular replacement prosthesis (PORP) was used in 48 cases, with significant improvement in air-bone gap (ABG) from 29.52 ± 13.11 dB preoperatively to 18.48 ± 11.18 dB at last FU (p < 0.01). No significant difference in ABG improvement was observed among different PORP materials and techniques (p = 0.70). Total ossicular replacement prosthesis (TORP) was employed in 29 cases, with a non-significant ABG improvement (p = 0.12). However, titanium TORP yielded significantly better outcomes compared to bone and semi-synthetic materials (p < 0.01 and p = 0.03, respectively). At last FU (mean 30.78 ± 24.44 months), ears with a healthy neotympanum (74 %) showed significantly better hearing outcomes than those with disease recurrence (p = 0.04). Conclusion: This study supports the use of transcanal endoscopic ossiculoplasty (OPL) as a safe and effective technique for improving hearing in pediatric patients with conductive or mixed hearing loss due to middle ear disease. The preference for autologous materials in partial reconstruction reflects their biocompatibility and established performance. TORP outcomes varied significantly by material, with titanium prostheses providing the best hearing improvement. Disease recurrence significantly affects hearing outcomes, emphasizing the challenge of achieving a stable and ventilated middle ear to guarantee optimal OPL results.