Objective: To review the surgical procedures and outcomes in children with bilateral oval window aplasia (OWA). Study Design: Retrospective cohort review. Setting: Tertiary referral center. Patients: Children suffering from OWA between 1990 and 2010. Intervention: Vestibulotomy with ossiculoplasty (V-OPL) or round window vibroplasty (RWV). Main Outcome Measures: Findings at radiology and surgery, preoperative and postoperative bone conduction (BC), air conduction (AC), and RWV-air conduction

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... V-AC) thresholds and speech discrimination scores (SDSs). Results: Among 23 children, 11 underwent V-OPL and 8 RWV. Four children in the V-OPL group had aborted surgery and were excluded from the study. In all the remaining 19 children, the 6-month follow-up time showed postoperative AC and SDS values significantly better than the preoperative thresholds in both groups. At the 36-month long-term follow-up, AC and SDS were stable in the RWV group but showed a significant worsening in the V-OPL children compared with the 6-month follow-up results. Preoperative versus postoperative BC values showed a significant difference between the 2 groups at 36 months; 5 of the V-OPL group underwent revision following the same surgical principles, which did not result in improved outcome. Conclusion: In children with OWA, V-OPL provides modest long-term results and carries higher risks of BC degradation compared to RWV. Both procedures are technically challenging but considering the respective hearing results and morbidity of primary and revision surgery, we have abandoned the V-OPL procedure in favor of RWV. In infants and children younger than 5 years with OWA previously not considered candidates for hearing restoration, we consider RWV as the first-choice surgery. It has shown to provide significantly better hearing outcomes than traditional atresia surgery with minimal complication rate.