Pediatric ossiculoplasty and implications in cholesteatoma surgery.

This review explores the current understanding and clinical considerations of ossiculoplasty in pediatric patients, focusing on ossicular chain reconstruction associated with congenital or acquired cholesteatoma. The goals of this review are to review the current literature on diagnostic approaches, surgical timing and techniques of pediatric ossiculoplasty. Current literature suggests that pediatric cholesteatoma tends to be more aggressive than in adults, often necessitating staged ossiculoplasty for better long-term outcomes. Diffusion-weighted MRI, particularly nonecho planar imaging (non-EPI DWI), is a valuable surveillance tool, though its diagnostic accuracy in children remains lower than in adults. The choice of prosthesis - total vs. partial ossicular replacement and titanium vs. autologous materials - significantly influences outcomes. Additionally, endoscopic ossiculoplasty has emerged as a viable and often preferable alternative to microscopic approaches, offering comparable audiologic outcomes with fewer complications. The success of pediatric ossiculoplasty after treatment of cholesteatoma depends on several factors including timing of surgery, prosthesis type, and middle ear status. Because cholesteatoma can be more aggressive in children, a tailored and staged approach, combined with advances in imaging and endoscopic techniques, is essential for optimal management. Future directions point toward personalized solutions using 3D modeling and biocompatible implants to further enhance outcomes.