Ossicular Chain Reconstruction Research Articles

Surgical treatment of external auricular cholesteatoma involving tympanum and papilloma

Objective:To explore the operation treatments and their outcomes of external auditory canal cholesteatomas involving the tympanic cavity and mastoid process. Method:Forty-two patients (45 ears) with external auditory canal cholesteatomas were included in this study who were operated. All lesions invaded the tympanic cavity and mastoid process. Excision of cholesteatoma, external auditory canal angioplasty and concha formation were performed. Ossicular chain reconstruction was performed in 3 ears. Mastoidectomy with close technique were performed in 4 ears. Open radical mastoidectomy was performed in 5 ears. Posterior bone-wall of auricular meatus reconstruction was performed in 3 ears. Tympanoplasty was performed in 21 ears. Pure tone audiogram and aural endoscope were carried out after the operation (3 months, 6months, 1 year, 2 years, 3 years…). Result:Stricture of external auditory meatus were occured in 2 ears in 2 and 3 months after surgery respectively. Cholesteatoma recurrence was observed in 2 ears in 1 year after operation. Wet ear was observed in 1 patient and then another operation was performed after 7 months. Besides the patients above, the epitheliums of the cavity were well in all other patients with complete tympanic membranes. Hearing was improved in all patients (hearing by air conduction:5－30 dB HL). Conclusion:According to the range of the external auditory canal cholesteatoma, we took different operation methods including tympanoplasty, open or close radical mastoidectomy and reconstruction of posterior wall of external auditory canal etc. Those methods, including external auditory canal angioplasty, cavity plasty of concha and skin grafting of external auditory canal, could help to prevent scar formation and stricture of external auditory canal, prevent cholesteatoma recurrence and improve hearing.

Audiological Results of Total Ossicular Replacement Prosthesis with Cartilage Shoe Technique.

The aim of this study was to investigate functional results of total ossicular replacement prosthesis (TORP) shaft stabilization with a cartilage shoe in chronic otitis media patients with cholesteatoma who had undergone canal wall down tympanomastoidectomy (CWDT). In addition, it was determined whether the presence of granular and edematous mucosa in middle ear altered functional outcomes. Sixty patients, who had undergone CWDT with the use of TORP for the reconstruction of ossicular chain, were divided into two groups. Patients with cartilage shoe were classified as Group 1 (n=30) and those without the shoe were classified as Group 2 (n=30). Patients in both groups were classified into "A" and "B" subgroups according to the middle ear risk index (MERI). Air conduction (AC) and bone conduction thresholds were evaluated preoperatively and postoperatively. There was no statistically significant change between preoperative AC thresholds of the groups and subgroups (p>0.05). There were statistically significant differences regarding AC thresholds and air-bone gap (ABG) values between Groups 1 and 2 at the postoperative 12th month (p<0.05). Postoperative AC thresholds and ABG values of Group 1B patients with a high MERI score were statistically significant at all frequencies than those of Group 2B patients (p<0.05). When ABG values were compared, it was observed that functional results were better in Group 1B, but a statistically significant difference was observed only at 2000 Hz (p<0.01). The cartilage shoe method for titanium TORP stabilization that is used for ossicular reconstruction during CWDT has been found to have a beneficial effect on auditory outcomes. Cartilage shoe application increases positive effects on hearing outcomes, particularly if the middle ear mucosa is granular and edematous.

Aural Atresia with Cholesteotoma and Its Management Strategies.

The term congenital aural atresia is used to describe failure of external auditory canal to open. Thus it results in conductive hearing loss. There are ways to improve the transmission of sound to the healthy inner ear, we have performed surgery to open the ear canal and restore the natural sound-conducting mechanism to the inner ear. Thus avoiding multiple surgeries. The study was conducted among patients aged between 12 and 24years, our study included 8 patients with aural atresia with cholesteotoma. After a detailed examination of patients were subjected to surgery. In our study with the sample size of eight patients Where, all our patients underwent canal wall down mastoidectomy with simultaneous single stage reconstruction of ossicular chain. All our patients were discharge free and Had subjective improvement in hearing with the post operative period was well accomplished to < 35dB. In our study all eight patients who underwent canal wall down mastoidectomy had good hearing outcome. As to avoid unnecessary recurrence and complications which are usually seen in intact canal wall down mastoidectomies, we suggest canal wall down and single stage reconstruction.

Ossicular Chain Reconstruction in a Developing Country.

In Ethiopia, 2-stage operations with middle ear prostheses are economically unfavorable. We hypothesized that single-stage autologous ossiculoplasty results in acceptable tympanic membrane (TM) and hearing improvements in a setting of limited resources. One hundred eighty-eight patients (197 ears) who underwent 1-stage autologous ossiculoplasty for ossicular dysfunction are presented. All but 14 of these ears also had perforations of the TM. Conditions of the middle ear were granulation tissue, ossicular disruption only, tympanosclerosis, and cholesteatoma. Reconstructions of the ossicular chain were performed with autologous ossicles only. The closure rate of TM perforations was 95%. Preoperative air bone gaps were 27 to 60 dB (mean [SD] = 44 [7] dB); postoperative air bone gaps were 0 to 50 dB (average [SD] = 23 [10] dB), for an average improvement of 21 dB across all reconstruction types ( P < .001). The largest favorable changes in air bone gaps were with incus and malleus columellas from the footplate to the TM (33 and 23 dB, respectively) ( P < .001). No patient had worsening of sensorineural hearing levels or extrusion of the reconstructed ossicles. Autologous ossiculoplasty performed well in this setting. Acceptable TM closure rates and improvement of air bone gaps were seen in 1-stage operations without the use of prostheses.

Hearing Improvement After Type III Tympanoplasty: A Prospective Observational Study.

To analyse the postoperative hearing results of patients undergoing type III tympanoplasty using sculptured homologous spur cartilage. This prospective study included 156 patients of chronic otitis media (COM), between the ages 10-60years. All cases underwent type III tympanoplasty with ossiculoplasty using homologous spur cartilage. The study sample of 156 patients contained 107 cases of mucosal type and 49 cases of squamosal type COM. Type III A tympanoplasty was done for 71 cases and type III B tympanoplasty was done for 85. Pure tone audiometry (PTA) was done pre and postoperatively, in all the cases. The patients were followed up for 6months postoperatively. The average preoperative mean air-bone-gap (ABG) was 43.64dB, whereas in type III A cases it was 39.7dB and in type III B it was 46.9dB. The mean ABG at 6th month follow up was 18.9dB in the study group. In type III A cases, mean ABG was 15.2dB and in type III B cases it was 22.11dB. Homogenous spur cartilage graft can be used for ossicular chain reconstruction with the advantage of very low extrusion rate, technically easy to perform with less risk of residual disease.

Stapes Release in Tympanosclerosis.

: Tympanosclerosis in the middle ear space is common in Ethiopia and often involves the ossicles and particularly the stapes. Ear operations in Ethiopia are relatively expensive in this country of limited medical resources and a low average living wage. In this setting, 2-stage operations using prostheses become prohibitively expensive. Therefore, the recommended 2-stage approach for tympanic membrane perforation with tympanosclerosis and stapes fixation is impractical for Ethiopia.We present a series of 67 patients who had a single stage tympanoplasty, removal of tympanosclerosis from the stapes suprastructure, and ossicular chain reconstruction using ossicular interposition. Crucial is the surgical technique employed for peeling the mound of tympanosclerotic plaque off of the stapes, which we term the stapes release. Controls were 67 patients with similar perforations and air-bone gap, but no tympanosclerosis. Most controls had ossciular discontinuity and were reconstructed with type III tympanoplasty.Air-bone gap improved in both groups: 18 dB (11 dB standard deviation) in the stapes release group, and 23 dB (11 dB standard deviation) in the control group. Paired t test found these improvements in each group significant at p < 0.001. Among the preoperative subjects there were 40 with air-bone gap greater than 45 dB, and none less than 20 dB. Among the postoperative subjects, none had air-bone gap worse than 45 dB, while 25/67 (37%) stapes release and 44/67 (66%) controls had air-bone gap better than 20 dB. Three patients in each group failed to close their perforations completely (96% closure rate).The only complications were two early cases of transient facial nerve weakness, which was avoided in subsequent cases by an alteration in technique. There was no deterioration of sensorineural hearing levels in either group's subjects postoperatively.In conclusion, stapes release with ossicular interposition can be performed at the same time as tympanoplasty without exacerbation of sensorineural hearing loss. Tympanic membrane closure and hearing levels were similar between patients with and without stapes fixation from tympanosclerosis.

Comparison of Various Graft Materials in the Reconstruction of Ossicular Chain in Patients with Chronic Otitis Media: A Prospective Hospital Based Study

Introduction&#x0D; Ossicular chain reconstruction is the surgical procedure used to correct the hearing problems in patients with chronic otitis media (COM). In this era, where a large variety of innovative artificial prosthetic materials are being used to replace and reconstruct the ossicular chain, autografts still play a significant role.&#x0D; Materials and Methods&#x0D; The present study included 40 patients. Study population was selected based on inclusion and exclusion criteria. The ossicular reconstructive procedure was done under anesthesia and according to the status of the ossicular chain. Temporalis fascia was used to close the perforation. Mainly two procedures were performed: one is intact canal wall and the other is canal wall down. &#x0D; Results &#x0D; Most of the study population was middle aged and males were more compared to females. Thirty five patients had air bone gap above 30dB. In 38 patients, the incus had undergone necrosis. Most of the patients underwent short columella reconstruction. A closure of air bone gap with in 20 dB was achieved in 72.2% in patients with malleus stapes assembly. In short columella 22.2% of patients had closure of air bone gap within 20 dB. Incus remnant grafts gave better hearing gain.&#x0D; Discussion&#x0D; The published literature on the result of use of sculptured ossicle and cartilage in tympanoplasty have been reviewed&#x0D; Conclusion &#x0D; In the present study, cases with COM showed good hearing results patients implanted with autogenous cartilage and bone.

Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n = 72) received MeroGel as the MEPA, Group 2 (n = 64) cartilage, and Group 3 (n = 69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.Results: Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p < .05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p < .05).Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.

Audiometric Outcomes Following Endoscopic Ossicular Chain Reconstruction.

To evaluate the audiometric outcomes following endoscopic ossicular chain reconstruction (OCR). Retrospective case series. Two tertiary referral centers. Sixty two ears with ossicular discontinuity. Endoscopic and microscopic OCR in patients with ossicular discontinuity. Bone and air pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Sixty two ears were included for analysis. Patients that underwent ossiculoplasty were subdivided based on prosthesis type (total ossicular replacement prosthesis [TORP] and partial ossicular replacement prosthesis [PORP], primary and staged ossiculoplasties, and surgical approach [microscopic and total endoscopic]). Forty two ears required PORP reconstructions, while 20 ears required TORP reconstructions. The microscope was used to reconstruct the ossicular chain in 31 cases, while an exclusive endoscopic approach was used in the remaining 31 patients. Controlling for the prosthesis, there were no significant postoperative differences in bone PTA, air PTA, and ABG between primary and staged ossiculoplasties, or surgical approach. Controlling for the type of prosthesis, there were no significant differences in hearing outcomes with respect to staged ossicular chain reconstruction or whether the endoscope or microscope was used for visualization. Thus, in this series, endoscopic OCR yields similar audiometric outcomes when compared with microscopic OCR.

Long-term Follow up and patient satisfaction after tympanoplasty with Titanium Clip-Prothesis

Aim of the present study is to evaluate the long term results of ossiculoplasty using titanium clip prosthesis. A retrospective analysis with prospective follow-up has been done including for all patients who had a Clip-PORP implanted between the years 2002-2013. Following this, audiometric hearing results were measured with clinical examination including otoscopy and quality of life evaluation using Glasgow benefit inventory. 48 patients (51 ears, 29 men, 19 women, average age 44.1 years) received followed up after an average duration of 6.3 years. The overall air-bone-gap (0.5-4 kHz) decreased from 22.8 dB preoperatively to 14.6 dB postoperatively (p≤0.001). The most frequent indication for surgical treatment were cholesteatomas and recurrent cholesteatomas (52%), chronic inflammation of middle ear (12%), revision of radical mastoidectomy (8%) and disturbance in sound conduction after previous operation (14%). Tympanic membrane was closed in 47 times (92,2%), 4 times (7,8%) there was a defect. Clip-PORP was in situ 39 times (75%), protrusion and disposal were detected 6 times (11,8%) and 2 times (4%), respectively. However, 1 time (2%) the prothesis was lost or evaluation was not possible (3 times, 5,9%). The overall patient satisfaction and general subscale score after the treatment was beneficially evaluated. There was no change in social support score nore the physical health score. In summary, the ossicular chain reconstruction using titan Clip-PORP is safe and well established. Also in long-term analysis stable hearing results due to reduction of air bone gap are represented. The subjective quality of life is sustainable improved.

A retrospective study of 54 cases with chronic otitis media prepared for staging tympanoplasty

Objective:To analyze the clinical effect of 54 cases with chronic otitis media prepared for staging tympanoplasty and 19 cases finished staging ossicular reconstruction surgery, evaluate the advantages of different surgery technique.Method:Fifty-four cases with chronic otitis media were planned for staging tympanoplasty surgery and had been received the first stage surgery. Silicagel plates were placed in the tympanic cavity in order to prevent adhesions. Among them, 19 cases had received the second stage ossicular reconstruction, including 10 cases with TORPs and 9 cases with PORPs. The average air bone gaps (ABG) were measured at four frequencies: 500, 1 000, 2 000 and 4 000 Hz.Result:Among the 54 cases, 45 cases had swollen mucosa in the tympanic cavity and eustachian tube, 18 cases had tympanic fibrous adhesions, and 12 cases had fixed or sclerotic stapes. The preoperative ABG of the 54 cases were (38.26±7.88)dB. As for the 19 cases finished the second stage surgery, their preoperative ABG in the first stage were (39.21±7.05)dB, the preoperative ABG in the second stage were (38.82±11.43)dB, and the postoperative ABG after the second stage were (21.77±11.92)dB. The hearing function after staging tympanoplasty was significantly improved compared with the preoperative hearing in the first and the second stage operation (P< 0.01). In addition, the second stage surgery of three cases was postponed because of a good postoperative hearing with (10.42±10.63)dB ABG after the first stage surgery. Up to now, none of the 54 cases suffered from facial palsy, infection and other complications after surgery.Conclusion:Staging tympanoplasty is an important technique to improving hearing and reducing the complications, especially for the cases with chronic otitis media unsuitable for one stage reconstruction of ossicular chain.

Clinical observation on the treatment of intractable otomastoiditis with reconstruction of external auditory canal wall

Objective:To observe the clinical effect on the treatment of intractable tympanitis with reconstruction of external auditory canal wall.Method:Five cases underwent radical removel of residual lesion and reconsruction of external auditory posterior canal wall using hydroxyapatite ceramic wall with transferred pedicle temporalis fascia covering on it were analyzed. The implement of ossicular chain reconstruction depends on the probing for tympanic cavity intraoperatively. Periodic review were conducted in the 1st, 3rd, 6th, 12th month after surgery.Result:All 5 cases gained dryears within 3 months after surgery, in which hearing of 3 cases improved and ABG were within 20 dB. 1 cases showed no improvement compared to preoperation, and 1 case gained a worse audiology result. Central part of the transplant of 1 case was naked, while peripheral part had been epithelization and external auditory canal gained no accessible to mastoid cavity, the patient were also found recurrence of cholesteatom inside the mastoid cavity when received CT examination during outpatient follow-up one year postoperatively, and underwent correction surgery. 1 case underwent revision operation for a fistula between the reconstructed wall and the skin of the outer auditory canal. No surgical complications like infection or facial paralysis occurred, all patients were satisfied with surgery effect.Conclusion:HA with transferred vascularized temporalis fascia pedicle for the reconstructon of the external auditory canal wall is an effective method for the treatment of intractable tympanitis, and worth promoting.

Endoscopy-Assisted Ear Surgery for Treatment of Chronic Otitis Media With Cholesteatoma, Adhesion, or Retraction Pockets.

The objective of this study was to analyze the results of endoscopy-assisted ear surgery for the treatment of chronic otitis media with cholesteatoma, adhesion, or retraction pockets.Fifty-one patients who underwent oto-endoscopy-assisted canal wall up tympanomastoid surgery and/or limited anterior atticotomy with tympanoplasty for chronic otitis media with cholesteatoma, adhesion, or retraction pocket from 2006 to 2013 have been included in this study. Eradication of the disease from the middle ear and mastoid air cells was achieved by combination of the oto-microscobic and oto-endoscopic approaches. Second look surgery was performed 18 months later from the initial surgery in selected patients. Age, gender, pre-/postoperative otoscopy findings/audiograms, type of the used prostheses, and follow-up time were obtained from the patient's file. Anatomic integrity rates of the tympanic membrane, the mean gains of air bone gap, on pure-tone audiogram at 4 frequencies and existence of the residual disease were reviewed parameters. Functional evaluation was made in patients with intact tympanic membrane.Of the 51 patients, the ratios of the chronic otitis media with cholesteatoma and isolated adhesive otitis or retraction pocket cases were 74.5% (38/51) and 25.5% (13/51), respectively. Ossicular chain reconstruction was made with PORP in 27 patients and TORP in 20 patients, whereas the ossicular chain was intact in 4 patients. Anatomic integrity rates of the tympanic membrane were 90.2% (46/51). The overall (n = 46) pre-/postoperative mean ABG obtained at 4 frequencies were 28.3 ± 12.26 and 9.18 ± 5.68 dB (P < 0.0001) respectively. Residual cholesteatoma rate was 10.5% (34/38) for chronic otitis media with cholesteatoma patients. However, there was no recurrence or new cholesteatoma formation in isolated retraction pockets or adhesive otitis patients.Oto-endoscopic eradication of the cholesteatoma or epithelial tissue from hidden area after the all visible cholesteatoma removal by oto-microscope improves the quality of surgery, significantly decreases the frequency of the canal wall-down procedure and posterior tympanotomy requirements with acceptable residual cholesteatoma rates.

Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma.

To evaluate the clinical parameters, outcomes, and complications of transcanal endoscopic ear surgeries for middle ear cholesteatoma. Retrospective study. Tertiary university-affiliated medical center. Adult patients (age >18) who underwent transcanal endoscopic ear surgeries for cholesteatoma, between March 2009 and March 2015. Transcanal endoscopic surgery was indicated when the cholesteatoma did not extend posterior to the anterior limb of the lateral semicircular canal. Rigid endoscopes 4 and 2.7 mm in diameter, 0, 30, 45, and 70 degrees were used with angled picks, suction, and forceps.Preoperative assessment included high-resolution computed tomography of the temporal bones and/or non echo-planar diffusion-weighted magnetic resonance imaging and pure-tone audiometry. Residual or recurrent disease was diagnosed by clinical examination and/or magnetic resonance imaging findings consistent with cholesteatoma. Intra- and postoperative complications, pre- and postoperative audiometric results were recorded. Sixty operations (56 patients, mean age = 43.6) were included.Six operations (10%) were performed under local anesthesia. The most common sites of cholesteatoma involvement were: posterior epitympanum (n = 51, 91%), anterior epitympanum (n = 19, 33.9%), posterior mesotympanum (n = 13, 23.2%), and sinus tympani (n = 11, 19.6%). Intraoperative ossicular chain reconstruction was performed in 18 (30%) cases.Our overall residual and recurrence rates were 10% (n = 6) and 8.3% (n = 5), respectively, with mean duration of follow up of 35 months. The most common sites of residual disease were the mastoid cavity/antrum (n = 3, 50%), tympanic cavity, and posterior mesotympanum. Overall minor and major complication rates were 16.6 and 6%, respectively. Transcanal endoscopic ear surgery was found to be an acceptable and safe technique for the exposure and eradication of middle ear and/or attic cholesteatoma.

Factors influencing hearing outcomes in pediatric patients undergoing ossicular chain reconstruction

ObjectiveOssicular chain disruption in children leads to conductive hearing loss. Few studies have focused on factors influencing successful results in pediatric ossicular chain reconstruction (OCR). We aim to determine whether demographic or surgical factors affect hearing outcomes in pediatric OCR. MethodsWe conducted a retrospective chart review of 120 patients undergoing OCR at our institution, a tertiary care hospital, between 2003 and 2014, with median length of follow-up of 2.2 years (range 0.1–9.3 years). Pediatric patients (<18 years old at time of surgical procedure) who had current procedural terminology (CPT) codes of OCR, and available pre- and post-operative audiograms were included in the study. Demographic information, surgical details, and pre- and post-operative pure-tone averages (PTA), speech reception thresholds (SRT), and air-bone gaps (ABG) were recorded from clinic notes, audiograms and operative reports. Differences between PTA, SRT and ABG pre- and post-operatively, as well as demographic and surgical factors, were evaluated using Wilcoxon rank-sum tests. Factors influencing revision were evaluated using Log-rank tests. ResultsA total of 120 patients (123 ears) were included. 35.8% of cases were revised, most commonly due to displaced prostheses. 28.5% of surgeries resulted in normal hearing (PTA ≤25 dB) post-operatively. Post-operative SRT and ABG were significantly better in patients with partial ossicular replacement prosthesis (PORP) compared with those with total ossicular replacement prosthesis (TORP) (p = 0.016, 0.027). Titanium prostheses resulted in better post-operative PTA and larger changes in PTA compared with all other materials (p = 0.034, p = 0.038). ConclusionsIn our experience, children with titanium prostheses had better hearing outcomes than those with other materials, and children with PORP had better hearing outcomes than those with TORP.

Long-term Follow up and patient satisfaction after tympanoplasty with Titanium Clip-Prothesis

Aim of the present study is to evaluate the long term results of ossiculoplasty using titanium clip prosthesis. A retrospective analysis with prospective follow-up has been done including for all patients who had a Clip-PORP implanted between the years 2002-2013. Following this, audiometric hearing results were measured with clinical examination including otoscopy and quality of life evaluation using Glasgow benefit inventory. 48 patients (51 ears, 29 men, 19 women, average age 44.1 years) received followed up after an average duration of 6.3 years. The overall air-bone-gap (0.5-4 kHz) decreased from 22.8 dB preoperatively to 14.6 dB postoperatively (p≤0.001). The most frequent indication for surgical treatment were cholesteatomas and recurrent cholesteatomas (52%), chronic inflammation of middle ear (12%), revision of radical mastoidectomy (8%) and disturbance in sound conduction after previous operation (14%). Tympanic membrane was closed in 47 times (92,2%), 4 times (7,8%) there was a defect. Clip-PORP was in situ 39 times (75%), protrusion and disposal were detected 6 times (11,8%) and 2 times (4%), respectively. However, 1 time (2%) the prothesis was lost or evaluation was not possible (3 times, 5,9%). The overall patient satisfaction and general subscale score after the treatment was beneficially evaluated. There was no change in social support score nore the physical health score. In summary, the ossicular chain reconstruction using titan Clip-PORP is safe and well established. Also in long-term analysis stable hearing results due to reduction of air bone gap are represented. The subjective quality of life is sustainable improved.

Titanium Ossicular Chain Reconstruction Revision Success and Preoperative Factors Predicting Success.

Objective Determine rates of success after revision titanium ossicular chain reconstruction with either partial or total ossicular replacement prosthesis and assess preoperative factors predicting positive outcomes. Study Design Case series with planned data collection. Setting Tertiary hospital. Subjects and Methods The charts of 76 surgical patients who underwent revision titanium ossicular chain reconstruction from 2003 to 2014 were abstracted from a prospectively maintained database at the Medical University of South Carolina. Postoperative air-bone gap (ABG) after revision surgery at short-term (<6 months) and intermediate to long-term (>1 year) follow-up and preoperative factors associated with postoperative ABG ≤20 dB were recorded. A paired t test or Wilcoxon signed-rank sum test was utilized to compare preoperative, short-term, or intermediate to long-term results. Results Seventy-six patients underwent revision ossiculoplasty and met inclusion criteria. Mean postoperative ABG was 22.5 at short-term follow-up ( P < .0001) and 24.4 at intermediate to long-term follow-up ( P = .003). Postoperative ABG ≤20 dB was achieved in 51.5% of patients. The only preoperative factor associated with postoperative ABG ≤20 dB was location of original primary ossiculoplasty ( P = .01). Conclusions This is one of the larger studies involving revision titanium ossiculoplasty. Revision surgery showed a significant improvement in postoperative ABG. The location of the original ossiculoplasty correlated with success of revision surgery (defined as postoperative ABG ≤20 dB). Patients who had the primary ossiculoplasty at an outside hospital may have better audiometric outcomes than patients who had it at a tertiary hospital.

A study of various graft materials used for ossicular chain reconstruction at tertiary health care centre

A study of various graft materials used for ossicular chain reconstruction at tertiary health care centre

Diagnosis and surgical reconstruction results for 14 cases of patients with congenital ossicular chain malformation

Objective:To investigate the diagnosis of common congenital ossicular chain malformation and the efficacy of ossicular chain reconstruction. Method:Fourteen cases with 15 ears of congenital ossicular chain malformation were included, consisting of 10 cases unilateral conductive hearing loss(10 ears), 1 case bilateral conductive hearing loss (2 ears) and 3 cases unilateral mixed hearing loss with significant conductive hearing loss(3 ears). Tympanoplasty was proceed on all 15 ears, 1 ear was proceed by loosen the cartilage fixation of ossicular chain and tympanic cavity wall. Fourteen ears were proceed with ossicular chain reconstruction, including 3 ears with TORP,10 ears with PORP and 1 ear with artificial stapes operation. The efficacy was measured by comparing the values of air bone gap(ABG) before and after the operation. Result:The average ABG of pre-operation was 39.9 dB, the ABG for 3 week and 6 to 8 months after operation were 22.3 dB and 19.6 dB, which were 17.6 dB and 20.3 dB improve respectively(t=22.10, P<0.01 and t=12.813，P<0.01). Conclusion:Operation is the first choice for those conductive hearing loss causing by simple congenital ossicular chain malformation, relevant ossicular chain reconstruction due to particular situation of the surgery can significantly improve hearing.

Electrocoagulation improving bone cement use in middle-ear surgery: short-term and middle-term results.

Bone cement is used for ossicular chain repair and revision stapes surgery. Its efficient use requires cautious removal of mucosa from the ossicles. This paper reports a technique for easy, fast and safe removal of this mucosa prior to cement application. It consists of the application of monopolar electrocoagulation on the ossicles prior to bone cement application. The outcomes of six cases of revision stapes surgery and seven cases of partial ossiculoplasty, conducted between 2007 and 2012 using this new technique, were evaluated. Intra-operative reports and audiometric data were collected. During the last assessment, reconstruction using bone cement resulted in mean post-operative air-bone gaps of 4.1 ± 6.5 dB in revision stapes surgery cases and 5.7 ± 5.5 dB in partial ossiculoplasty cases, reflecting a significant hearing improvement (p = 0.03). No complications were observed. Electrocoagulation allows the removal of mucosa from the ossicles in an easy, fast and safe manner, enabling the use of bone cement for ossicular chain reconstruction.