Does Age at Surgery Influence Outcomes in Pediatric Ossicular Chain Fixation? A Multi-institutional Database Study

Introduction: The optimal timing of surgical intervention for pediatric ossicular chain fixation has not been well studied. Although ossiculoplasty is performed across a wide pediatric age range, it remains unclear whether age at surgery influences revision middle-ear surgery rates or postoperative complications.

Methods: A retrospective database study was performed using the TriNetX Research Network (2010–2024). Pediatric patients undergoing tympanoplasty or ossiculoplasty for ossicular chain fixation or congenital ossicular malformations were identified using procedural billing codes. Patients with otosclerosis, cholesteatoma, chronic otitis media, temporal bone trauma, or syndromic craniofacial anomalies were excluded. Age at surgery was used as a surrogate for pubertal status, defining prepubertal ( < 10 years), peripubertal (10–14 years), and postpubertal (>14-18 years) cohorts. One-to-one propensity score matching was performed for sex and demographic variables. The primary outcome was revision tympanoplasty or ossiculoplasty within five years. Secondary outcomes included postoperative tympanic membrane perforation, otorrhea or infection, and postoperative diagnosis codes for hearing loss.

Results: In the prepubertal versus postpubertal cohort ( < 10 vs >14 years; 44 patients per group), five-year revision surgery rates were 22.7% and 29.5%, respectively (p=0.467). In the peripubertal versus postpubertal cohort (10–14 vs >14-18 years; 135 patients per group), revision rates were 31.1% versus 35.6% (p=0.439). When patients younger than 14 years were compared with those aged 14 years or older (171 patients per group), revision rates remained similar (32.2% vs 35.1%, p=0.567). Postoperative complication rates did not differ by age group.

Conclusions: Later timing of ossiculoplasty does not confer lower revision surgery or postoperative complication rates, indicating that surgical outcomes are independent of patient age and supporting intervention when clinically indicated rather than age-based timing.