Otosclerosis in children and adolescents: A clinical and CT-scan survey with review of the literature

Objective: To assess the role of the CT-scan in the preoperative evaluation of juvenile otosclerosis and to study additional outcome data. Design and setting: We performed a retrospective case series study from an academic referral hospital using data from 1992 to 2005. Patients and methods: We selected patients younger than 18-year-old who had undergone primary stapedectomy for otosclerosis among the 10 stapedectomies performed over the study period and analyzed the patients' systematic pre- and post-operative audiograms and CT-scan findings. Results: For this survey, complete data was available for 7 children, totaling 10 primary stapedectomies for otosclerosis. Their ages at diagnosis ranged from 10 to 17 years. In 4 children, CT-scan demonstrated bilateral findings typical of otosclerosis: poorly calcified foci near the fissula ante fenestram, associated with a hypodense edging surrounding the labyrinthine capsule in 2 children. The youngest patient had no CT-scan abnormalities. Stapedectomy was performed in one case and laser stapedotomy in 9 cases. Seven children were immediately improved following surgery and no postoperative facial palsy or prolonged vertigo was reported. The mean (S.D.) postoperative ABG was 6.5 dB (+/-3.7). The mean closure was 19 dB (+/-11.2). The mean change in high-tone bone conduction level was 1.8 dB (+/-7.5). Six children had a postoperative ABG less than 10 dB while in one, the ABG was inferior to 20 dB. Conclusion: Preoperative CT-scan is useful for the preoperative diagnosis of otosclerosis in children. The images seen must be distinguished from other footplate pathologies or deformities of the ossicular chain which are often associated with poorer surgical results. This survey provides additional evidence that stapes surgery is an effective procedure for treating juvenile otosclerosis. (C) 2007 Elsevier Ireland Ltd. All rights reserved.