Fibrous Incudostapedial Joint in Congenital Aural Atresia

• Published in: Otolaryngology-head and neck surgery Vol. 150; no. 4; pp. 673 - 676
• Main Authors: Balaker, Ashley E., Roberson, Joseph B., Goldsztein, Hernan
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-04-2014
• Subjects: Audiometry - methods; aural atresia; Child; Child, Preschool; Cohort Studies; conductive hearing loss; Congenital Abnormalities - diagnosis; Congenital Abnormalities - pathology; Congenital Abnormalities - surgery; Ear - abnormalities; Ear - pathology; Ear - surgery; Female; Follow-Up Studies; Hearing Loss, Conductive - congenital; Hearing Loss, Conductive - diagnosis; Hearing Loss, Conductive - surgery; Humans; incus; Incus - abnormalities; Incus - surgery; Male; microtia; Ossicular Prosthesis; ossicular reconstruction; Ossicular Replacement; Otoscopy - methods; Preoperative Care - methods; Retrospective Studies; Risk Assessment; stapes; Stapes - abnormalities; Stapes Surgery - methods; Tomography, X-Ray Computed - methods; Treatment Outcome; microtia; conductive hearing loss; stapes; ossicular reconstruction; aural atresia; incus
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599813519745

Objectives
(1) Determine the prevalence of a non-bony or fibrous incudostapedial (IS) joint in the setting of congenital aural atresia. (2) Assess this anomaly’s impact on surgical management and associated hearing outcomes.
Study Design
Retrospective chart review.
Setting
Subspecialty private practice.
Subjects and Methods
Operative reports and audiometric data of patients who underwent congenital aural atresia repair by a single surgeon from 2007 to 2011 were reviewed for operative anatomic findings and audiometric outcomes.
Results
Two hundred twenty-eight operations on 206 ears were performed. Median age was 5 years old. Fifty-five (26.7%) of these ears had a fibrous IS joint. The severity of this anomaly was graded as mild in 23 ears, moderate in 20 ears, and severe in 12 ears. Mean postoperative pure tone air conduction (PTA2) in the severely fibrous group was 51 compared to 46 in the moderate group (P = .03) and 41 in the mild group (P = .006). Patients with a fibrous IS joint who underwent successful ossicular chain reconstruction (OCR) had a mean postoperative PTA2 of 30, which was a significantly better outcome than in patients with moderately or severely fibrous IS joints who did not have OCR (P < .05).
Conclusion
A fibrous IS joint was seen in 27% of patients undergoing repair of congenital aural atresia. The severity of this anomaly has important implications for postoperative hearing results. These findings suggest that ossicular chain reconstruction should be performed in moderately or severely fibrous cases.