Middle Ear Risk Index as a Prognostic Factor in Pediatric Ossicular Reconstruction

Abstract

Objectives: To study the hearing results in children following ossicular reconstruction and to determine if the middle ear risk index (MERI) is a useful tool for predicting the outcome of surgery. Design: A retrospective case series. Setting: A tertiary academic center. Patients: Forty-four children underwent ossicular reconstruction using autologous or alloplastic prostheses from January 1995 to January 2005. Materials and Methods: Patients' audiograms were evaluated preoperatively and postoperatively for pure-tone average (PTA) and air-bone gap (ABG). Each ear was scored using the MERI and a total index was calculated. Results: 23 boys and 21 girls were included in the study. The mean preoperative ABG was 38 dB, and the mean postoperative ABG was 25.3 dB. The mean MERI was 3.40 for excellent results (0-10 dB postoperative ABG), 4.42 for good results (11-20 dB postoperative ABG), 4.45 for fair results (21-30 dB postoperative ABG), and 4.06 for poor results (ABG > 30 dB). The complications included perforation of tympanic membrane (13.6%), worsening of the conductive hearing loss (6.8%), retraction pockets (9.1%), recurrent or residual cholesteatoma (6.8%), high-frequency sensorineural hearing loss (4.45%), and prosthesis extrusion (2.3%). The mean follow-up period was 14 months. Conclusion: Children have poorer hearing outcome following ossicular reconstruction in comparison to the published adults' results. The MERI was not a reliable tool for predicting the hearing results of ossicular reconstruction in children.