Footplate reconstruction: preliminary results.

Abstract

A partially or fully absent or largely perforated footplate is a challenging condition that may be encountered during middle ear surgery, especially in patients with a history of chronic ear problems or with previous tympanoplasties. Retrospective study on a limited number of cases undergoing revision tympanoplasty in which a new footplate was created from the cartilage, and the ossicular chain was reconstructed with a titanium prosthesis in 1 stage. Minimum follow-up was 24 months. Outcome measurements included the preoperative and postoperative bone conduction to assess the function of the inner ear, and the preoperative and postoperative threshold levels of air and bone conduction in 4 frequencies to assess the possible hearing improvement. Six patients could be included. The audiologic results showed the average air conduction gain of 11 dB. We did not observe any significant deterioration in the bone conduction which, in some cases, even improved (average change of +3 dB). The symptoms related to a perilymphatic fistula were resolved. The technique described herein has proven to be safe and reliable. Reconstruction of the footplate with autologous cartilage and simultaneous type III tympanoplasty seems to be a promising solution for those rare but challenging cases in which the footplate is partially of fully absent.