Should ossicular reconstruction be staged after tympanomastoidectomy?

Abstract

Objectives: To determine whether ossicular reconstruction concurrent with tympanomastoidectomy results in significantly different hearing results when compared to ossicular reconstruction performed in a deferred procedure following tympanomastoidectomy. Methods: All patients undergoing ossicular reconstruction within a 2-year period were identified at a tertiary referral otology practice. These patients were segregated into 2 groups. Group 1 comprised those who had ossicular reconstruction concurrent with a tympanomastoidectomy for otomastoiditis with or without cholesteatoma. Group 2 comprised those who had a deferred ossicular reconstruction following tympanomastoidectomy. Pure-tone thresholds obtained on the last postoperative visit were noted. The frequency by which an air-bone gap (ABG) of less than 20 dB and less than 30 dB resulted were determined as well as mean final ABG for both groups. Results: Ninety patients were identified with a mean age of 37.6 ± 19.4 years. Forty-eight underwent ossicular reconstruction concurrent with tympanomastoidectomy while 42 underwent a staged ossicular reconstruction following tympanomastoidectomy. Within Group 1, 56.3% had a postoperative ABG<20 dB while a similar 54.8% of Group 2 had a postoperative ABG < 20 dB ( P = 0.341). In Group 1, 81.3% had ABG < 30 dB, and 81% of Group 2 had a postoperative ABG < 30 dB ( P = 0.353). Overall, Group 1 had a mean postoperative ABG of 20.8 dB while Group 2 had a similar mean postoperative ABG of 20.2 dB ( P = 0.744). Conclusions: Ossicular reconstruction concurrent with tympanomastoidectomy does not compromise the extent of postoperative hearing gain when compared to those who underwent a deferred ossicular reconstruction procedure following tympanomastoidectomy.