[Efficacy of stapes prosthesis surgery for congenital stapes fixation or oval window atresia in pediatric patients].

Objective: To explore the clinical efficacy of stapes prosthesis surgery for the treatment of congenital fixation of stapes or oval window atresia in pediatric patients. Methods: The clinical data of children with congenital fixation of stapes or oval window atresia who underwent stapes prosthesis surgery in Xi'an Children's Hospital from January 2017 to July 2025 were retrospectively analyzed. All the children underwent high-resolution computed tomography (HRCT) of the temporal bone and pure-tone audiometry before and after the surgery. According to the type of auditory chain deformity, the children were divided into the stapes fixation group and the oval window atresia group. The surgical methods included incudovestibular fenestration (IVF) and malleovestibulopexy (MVP), with four types of opening methods, namely stapes footplate drilling, stapes resection, vestibular windowing, and vestibular semicircular canal interposition, respectively. The preoperative and postoperative air-conducted pure tone average (PTA), bone-conducted PTA, and air-bone conduction difference (ABG) were observed and compared. Results: A total of 19 children (25 ears) aged (8.9±3.1) years were included, with 13 males and 6 females. There were 13 ears on the right side and 12 ears on the left side. Preoperative HRCT yielded a positive diagnostic rate of 56.0% (14/25), while the incidence of facial nerve malformation was 40.0% (10/25). Surgical intervention was performed in 24 of the 25 affected ears. Among these, 13 ears were diagnosed with stapes fixation, of which four underwent IVF and nine underwent MVP. The remaining 11 ears presented with oval window atresia, with four undergoing IVF and seven undergoing MVP. Six months postoperatively, both the stapes fixation group and oval window atresia group demonstrated statistically significant improvements in air-conduction PTA and ABG compared with preoperative values. In the stapes fixation group, air-conduction PTA decreased from (62.2±8.7) dB HL to (32.8±10.8) dB HL (P=0.002), and ABG improved from (49.3±10.5) dB HL to (22.5±5.8) dB HL (P<0.001). In the oval window atresia group, air-conduction PTA decreased from (66.2±8.4) dB HL to (42.0±11.6) dB HL (P<0.001), and ABG improved from (54.0±5.0) dB HL to (31.1±11.7) dB HL (P<0.001). No statistically significant differences were observed in bone-conduction PTA before and after surgery in either group (both P>0.05). Intergroup comparisons revealed that the stapes fixation group exhibited significantly greater improvements in postoperative air-conduction PTA [(32.8±10.8) dB HL vs (42.0±11.6) dB HL] and ABG [(22.5±5.8) dB HL vs (31.1±11.7) dB HL] compared with the oval window atresia group (both P<0.05). Subgroup analyses based on surgical technique showed that patients who underwent MVP in both the stapes fixation and oval window atresia groups achieved statistically significant reductions in ABG compared with preoperative levels (both P<0.05). In contrast, IVF did not yield statistically significant improvements in ABG in either group (both P>0.05). No statistically significant difference was detected in postoperative ABG between patients who underwent IVF versus MVP, nor among the four different types of window opening techniques (all P>0.05).All patients received outpatient follow-up at six months postoperatively. Nineteen ears were followed up for≥1 year, with a mean duration of (25.1±12.4) months, while five ears were lost to follow-up (loss to follow-up rate: 20.8%). No serious complications, including sensorineural hearing loss or facial paralysis, were reported in any patient. Conclusions: Stapes prosthesis surgery for the management of congenital stapes fixation and oval window atresia in pediatric patients demonstrates a favorable safety profile and sustained therapeutic efficacy. Surgical outcomes for congenital stapes fixation are superior to those for oval window atresia. Neither the choice between IVF and MVP nor variations in window-opening techniques has a statistically significant effect on postoperative hearing outcomes.