Bone cement or incus interposition in type 2 tympanoplasty: prognostic factors and functional outcomes

Abstract

In this study, we compared the functional results of incus interposition and the use of bone cement in patients who underwent type 2 tympanoplasty due to isolated incus defects. A total of 47 patients including 12 patients with incus interposition and 35 patients with bone cement were enrolled in the study. The middle ear risk indices (MERI) of the patients were evaluated from the patient files. The mean air conduction thresholds at 0.5, 1, 2 and 4 kHz and air-bone gap were estimated, evaluating preoperative and postoperative audiogram results at 12 months of all patients. The success rate of surgery and functional outcomes were compared between the patients of similar MERI groups on which ossicular reconstruction was performed using different methods (bone cement or incus interposition). In all patients, there was a statistical significant improvement in terms of the mean air conductance threshold and decrease in the mean air-bone gap (p<0.001, p=0.001). The comparison of percentage changes of functional gain between incus interposition and bone cement groups showed no statistically significant difference (p=0.542, p=0.534). In this study, similar functional outcomes were attained between the patient groups in which type 2 tympanoplasty with either sculptured incus interposition or bone cement was performed. Several factors including the cost of the material to be used, status of the middle ear and ossicles, defect size, and experience of the surgeon should be also considered.