Ossicular chain reconstruction in children: Outcomes of autologous incus interposition and TORP.

AIM: To compare hearing outcomes and prognostic factors in pediatric patients undergoing ossiculoplasty with autologous incus interposition (AII) or total ossicular replacement prosthesis (TORP).

METHODS

This retrospective study included 102 children under 18 who underwent tympanoplasty with ossicular reconstruction between 2021 and 2024. Patients were divided into two groups based on reconstruction type (AII or TORP). Audiological outcomes were assessed at short-term (6-12 months) and middle-term (>12 months) follow-up. Air conduction (AC), bone conduction (BC), and air-bone gap (ABG) thresholds were measured. Multivariate logistic regression was used to identify predictors of ABG closure ≤20 dB.

RESULTS

Among the 102 patients, 52 underwent AII, and 50 received TORP. At middle-term follow-up, ABG ≤ 20 dB was achieved in 72.5 % of AII patients versus 39.5 % in the TORP group (p = 0.003). AII patients also showed better AC thresholds (≤30 dB in 75.0 % vs. 57.9 %, p = 0.005) and greater hearing gain (13.1 ± 3.8 dB vs. 12.2 ± 4.3 dB, p = 0.028). Multivariate analysis identified intact stapes and AII use as independent predictors of success. Outcomes were also more favorable in cholesteatoma cases when the stapes were preserved.

CONCLUSION

AII offers superior middle-term hearing outcomes compared to TORP in pediatric ossiculoplasty. Stapes preservation and appropriate reconstruction technique selection are essential for optimal results.