Results Of Ossiculoplasty Research Articles

Study of Morphological and Anthropometric Features of Human Ear Ossicles.

To study the morphology and anthropometry of human ear ossicles from cadaveric temporal bone and to study the variations of the human ossicles from ossiculoplasty point of view. 38 sets of ear ossicles were collected, each containing malleus, incus and stapes, from temporal bone dissection done in Vasantrao Pawar medical college, Nashik. They were studied under microscope & anthropometrical, morphological evaluation done. Malleus showed variations in handle where 61% were straight and 39% curved. Weight of malleus ranged from 0.03-0.06gm. The length ranged from 5.5 to 8.2mm. Incus showed morphological variation in lenticular process which was present in 73% incii. Weight of incus ranged from 0.04 to 0.09gm, average length of long process 3.5mm, width of body 4mm. In stapes variations was seen with head of stapes which was absent in 21% bones. With increasing awareness about postop hearing status, this study will add up in knowledge of morphological and anthropometric variations that exists in Indian population, help otologists to understand middle ear dynamics better which will improve results of ossiculoplasty.

Long-term histological results of ossicular chain reconstruction using bioceramic implants.

Middle ear problems are addressed using tympanoplasty, which requires a mobile tympanic membrane and secure sound-conducting mechanism. The present is a long-term, retrospective, non-controlled study on the results of ossiculoplasty using bioceramic implants of autochthonous origin and which defined the statistical relevant factors that could influence the rate of implant rejection. In a cohort of 108 patients ossiculoplasties with bioceramic implants were performed and patients were followed up clinically for a period of minimum 7 years. Several factors were identified that could influence the results of the implantation and the statistical correlations were studied. The rejection rate after 9.12 years was 21% (23 patients). Histological integration rate was 79% (85 patients), similar to results reported in literature for both bioceramic and titanium implants. Hydroxyapatite has many of the ideal characteristics required to be a good prosthesis with a high degree of biocompatibility, very low extrusion rate, low risk of disease transmission and good functional results. Although perhaps considered of historical interest, bioceramic implants are cheaper and can be produced locally, which is a great advantage for struggling economies.

Anatomical and functional results of ossiculoplasty with adjustable length titanium prostheses with and without hydroxyapatite

To compare the anatomical and functional results of the ossicular chain reconstruction with classic titanium adjustable prostheses and titanium adjustable prostheses with hydroxyapatite cap. The 300 patients (360 cases) with chronic suppurative otitis media were examined and operated. The patients are divided into 2 groups. Group A included patients who received an ossicular prosthesis with a hydroxyapatite cap (90 cases with a partial prosthesis and 90 with a full one). Group B included patients who received prostheses without hydroxyapatitis (90 cases with a partial prosthesis and 90 with a complete one). The patients who received a prosthesis with a hydroxyapatite cap were divided into two subgroups, depending on the autotissue, which was placed between the prosthesis cap and the nontympanic membrane: this is an autocartilage plate or perichondrium/fascial graft. The follow-up period after surgery was 38.5±14.4 months (from 12 to 48 months). In the long-term postoperative period, the subjects were assessed the values of the bone-air gap (BAG), the consistency of the nontympanic membrane, and the presence of signs of extrusion of the prosthesis cap. Comparison of anatomical and functional results between patients with full and partial ossicular prostheses was performed separately. A good result in the form of a 20 dB or more dB BAG reduction was achieved in 82.2% of patients who received a partial prosthesis (85 patients in group A and 63 in group B), and in 57.8% of patients who received a complete prosthesis (45 patients in group A and 59 in group B). The BAG values in the long-term period after surgery did not statistically significantly differ between patients who received a prosthesis with a hydroxyapatite cap or a fully titanium one (p=0.939 for patients with full prostheses and p=0.745 for patients with partial prostheses). The placement of cartilage or perichondrium/fascial graft between the hydroxyapatite prosthesis cap and the nontympanic membrane also did not affect the functional outcome (with full prostheses - p=0.651, with partial prostheses - p=0.142). It is possible to use ossicular prostheses with a hydroxyapatite cap without placing an autocartilaginous plate between the nontympanic membrane and the cap of the prosthesis. In the long term period, functional and anatomical results with hydroxyapatite cap prostheses do not differ statistically significantly from those with all-titanium prostheses.

Hearing outcome following ossicular reconstruction for incus defects using partial ossicular replacement prosthesis

Background: Situation of incus erosion is common while performing tympanoplasties for cases of chronic otitis media. As none of the available techniques is said to be gold standard, a cost effective and easily available partial ossicular replacement prosthesis is employed and the postoperative hearing outcome is presented.
 Objectives: To assess the hearing results of ossiculoplasty using partial ossicular replacement prosthesis (PORP) during tympanoplasty.
 Methodology: A descriptive cross-sectional study was carried out in a tertiary referral hospital of Nepal from June 2018 to September 2019. Thirty consecutive patients who underwent tympanoplasty for chronic otitis media (inactive/mucosal) with incudostapedial discontinuity were operated using polytetrafluroethylene partial ossicular replacement prosthesis without removing the incus. Pure tone averages, air-bone gap (ABG) and air conduction gain were calculated pre and post-operatively.
 Results: There was no extrusion of prosthesis. The post-operative air-bone gap less than 20 dB was achieved in 23 (77%) cases. All the patients had post-operative air-bone gap of ≤25 dB. There were no major complications.
 Conclusion: Polytetrafluroethylene partial ossicular replacement prosthesis is safe, reliable and efficient alternative for ossiculoplasty when the incus is found to have eroded during tympanoplasty surgery.

The effect of age on ossiculoplasty results: A retrospective evaluation of 60 cases

ObjectiveThere are only a few studies evaluating ossiculoplasty results in the pediatric age group. Although the effect of different factors on the results of ossiculoplasty is investigated, the effect of age on ossiculoplasty results is not known. In this study, the effect of age on ossiculoplasty results has been investigated. MethodsThis retrospective clinical study was performed in 60 patients (30 female, 30 male; mean age 15.5±14.3 years, range 9–57 years) who underwent ossiculoplasty. The cases were divided into two groups according to their age. Group A consisted of pediatric cases younger than 18 years of age and group B consisted of adult subjects (>18 years). The comparison of the groups was made by taking into consideration the air-bone gap in the 3rd and 12th weeks of the pre- and postoperative period. ResultsThere was no statistically significant difference between preoperative air-bone gaps of the groups (p=0.086). In the third postoperative month, the air-bone gap gain of group A was statistically significantly higher than group B (p=0.0001). The air-bone gap gain of group A was significantly higher than group B in the postoperative 12th month (p=0.026). The air-bone gap gain of the patients with malleus in group A and group B was higher in the postoperative 3rd month than in the patients without malleus (all p values <0.05). There was no statistically significant difference between the air-bone gap gain in patients with the stapes suprastructure and the air-bone gap gain of the patients without stapes suprastructure in group A and group B in the postoperative 3rd month (p values >0.05). ConclusionThe results of ossiculoplasty were found better in the pediatric age group. We think that ossiculoplasty should be carried out without delay in the pediatric age group.

Long-term outcomes of ossiculoplasty using bone cement.

This study aimed to evaluate the long-term results of ossiculoplasty using bone cement. Forty patients (24 females and 16 males; mean age: 34.1 ± 11.8 years; range, 9-54 years) with chronic otitis media with perforation but without cholesteatoma who had undergone incudostapedial rebridging ossiculoplasty using bone cement were evaluated retrospectively. Pre-operative and post-operative audiograms were evaluated. Bone conduction, air conduction and air-bone gaps were calculated according to international guidelines. There was a mean reduction in pre-operative and post-operative air conduction (12.30 ± 11.98 dB), and this result was significant (p = 0.0001). There was a mean reduction in pre-operative and post-operative bone conduction (4.30 ± 6.69 dB), and this result was significant (p < 0.0001). The pre-operative air-bone gap was 27.65 dB and decreased to 19.65 dB during follow-up (p = 0.0001). No adverse reactions or complications were observed. Bone cement is reliable for the repair of incudostapedial-joint defects.

Prospective Study of Audiological Analysis of Ossiculoplasty in Cases of Chronic Suppurative Otitis Media

Background: Ossiculoplasty is defined as reconstruction of the ossicular chain using various graft materials and techniques. Aim: Audiological analysis with Pure Tone Audiometry (PTA) of results of ossiculoplasty in cases of safe and unsafe csom and its correlation with preoperative middle ear status using Kartush's Middle Ear Risk Index (MERI). Methodology: Non randomized prospective study conducted over 2 years in 34 patients with CHL; ossiculoplasty conducted with cartilage, remodeled autologous incus or malleus, malleostapediopexy and PORP; preoperative and 3 months postoperative PTA done. Kartush's MERI to correlate preoperative middle ear status with postoperative hearing results done. Out of 34 patients operated: 10-cartilage ossiculoplasty, 6-autologous incus, 2-autologous malleus, 4-PORP and 12-malleostapediopexy. Results and Conclusion: Hearing improvement was seen in all types of osssiculoplasties using various materials and techniques. However, there was no significant statistical difference between the various types in relation to the postoperative hearing improvement. Kartush's MERI was found to be an indicator of postoperative hearing improvement. It was found that as the value of the index increases, the postoperative hearing improvement decreases.

Study of hearing results of ossiculoplasty in patients with safe chronic suppurative otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ossicular discontinuity can occur as a result of erosion by chronic otitis media or due to trauma. Reconstruction of the ossicular chain aims to surgically optimize the middle ear transformer mechanism. The goal of this study was to devise a protocol to manage the ossicular discontinuity, provide good hearing to the patients and to demonstrate that use of ossicle for ossicular reconstruction is a safe, physiological, practical, successful and cost effective method.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study is retrospective study of 50 patients who underwent ossiculoplasty in our institute over the period of 2 years. Most patients presented to us with a history of chronic intermittent ear discharge and decreased hearing. Detailed clinical examination included general examination and local examination of ear, nose and throat. Examination of ear included otoscopy, tuning fork tests, and examination under microscope. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average pre-operative air-bone gap in patients with ossicular disruption was 34.95 dB and after ossiculoplasty was 12.93 dB. The mean air-bone closure after surgery was 27.88 dB. In most cases the post-operative air bone closure was within the range of 20 dB. The hearing results in ossiculoplasty are dependent on various factors but middle ear status in one of the most important factor in deciding the final outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The ossiculoplasty using autograft has stood the test of time and the results are superior to that of prosthesis. They have less rate of complications, are economic and easily available. The expertise to sculpt the ossicle can be easily developed with practice.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Anatomical and functional results of ossiculoplasty using titanium prosthesis.

SUMMARYTitanium ossicular chain replacement prosthesis is often used for rehabilitation of the columellar effect in otologic surgeries. This retrospective study aims to analyse the anatomical and functional results of surgeries in which a titanium prosthesis was used. Two hundred and eighty procedures in 256 patients operated on in a tertiary referral center were analysed. Aetiologies, preoperative audiograms, peroperative data and postoperative outcomes at 2 and 12 months postoperatively were reviewed. Chronic suppurative otitis media with or without cholesteatoma was the main aetiology (89%). There was no difference in anatomical results between partial and total ossicular replacement prosthesis, with an overall dislocation rate of 6%, and an overall extrusion rate of 3%. Regarding functional results, a postoperative air-bone gap ≤ 20 dB was achieved in 65% of cases, with a better result for partial compared to total ossiculoplasty (p = 0.02). A significant difference in air bone gap closure was found when comparing aetiologies, with a higher air-bone gap closure in malformation cases compared to chronic suppurative otitis media with cholesteatoma or retraction cases (p = 0.03). Ossiculoplasty using titanium prosthesis is a safe and effective procedure for rehabilitation of hearing loss, which allows reaching an air-bone gap ≤ 20 dB in the majority of patients.

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.

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.

Ossiculoplasty in chronic otitis media: Surgical results and prognostic factors of surgical success

Background and objectivesThe goal of ossiculoplasty is to improve hearing. Successful ossiculoplasty depends on several factors. This retrospective study was carried out to analyze hearing results of ossiculoplasty in ears with chronic otitis media (COM) and evaluate clinical outcomes and factors predictive of hearing improvement. Subjects and methodsWe reviewed the results of 153 patients with COM (with cholesteatoma (COMC) and without cholesteatoma (COMWC)) who underwent ossiculoplasty between January of 2002 to December of 2011. Several potential prognostic factors were evaluated: cholesteatoma present vs absent; type of surgical procedure, state of the middle ear mucosa, state of the ossicular chain, type of prosthesis. ResultsWe analyzed 153 ossiculoplasties: 96 patients presented COMWC and 57 patients presented COMC. The ossiculoplasties were performed using autologous ossicles for the most part. All ossiculoplasties were carried out in one-stage surgery. In 38% of cases ossiculoplasty was combined with mastoidectomy; in the remaining 62% of cases, ossiculoplasty was performed without mastoidectomy. Ossiculoplasty was successfully achieved in 113 patients (74%). The presence of the stapes superstructure and normal mucosa were significant predictive factors of surgical success. ConclusionThe majority of the ossiculoplasties improved hearing status satisfactorily. Multivariate analysis should be performed to investigate prognostic factors of favorable short-term hearing outcomes after ossiculoplasty. Better knowledge of these predictive factors may contribute to the surgeon's judgment and the information given to patients.

Ossiculoplasty: study of hearing results in 50 patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ossiculoplasty improves conductive hearing loss. Various reconstruction methods and techniques are developed with use of different graft materials over period of time. Results of ossiculoplasty can be predetermined with consideration of prognostic factors&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study is retrospective study of 50 patients who underwent ossiculoplasty in the medical college hospital over the period of 3 years i.e. from January 2013 to December 2016. The pre-operative and post-operative audiometric findings were documented and analyzed to study the hearing improvement with the use of auto graft malleus and incus for ossiculoplasty. The results of ossiculoplasty were also compared with other studies done for ossiculoplasty. Predictors of ossiculoplasty results such as ossicular status and middle ear mucosa were also studied&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average post-operative air bone gap was 12.92 dB. The mean post-operative ABG was within 20 dB in both primary and revision cases. Average air-bone closure in patients with normal mucosa was 32.1 dB and that of adhesive mucosa was 18 dB. Significant improvement in post-operative air-bone closure (p &amp;lt;0.01) was observed in patients with auto graft incus than malleus head as ossiculoplast&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 84% ossiculopasty patients were having post-operative air bone gap within 20 dB. The ossiculoplasty using auto graft ossicle is physiological, biocompatible, stable and has low complication rate&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Ossiculoplasty in chronic otitis media: Surgical results and prognostic factors of surgical success

Background and objectivesThe goal of ossiculoplasty is to improve hearing. Successful ossiculoplasty depends on several factors. This retrospective study was carried out to analyze hearing results of ossiculoplasty in ears with chronic otitis media (COM) and evaluate clinical outcomes and factors predictive of hearing improvement. Subjects and methodsWe reviewed the results of 153 patients with COM (with cholesteatoma (COMC) and without cholesteatoma (COMWC)) who underwent ossiculoplasty between January of 2002 to December of 2011. Several potential prognostic factors were evaluated: cholesteatoma present vs absent; type of surgical procedure, state of the middle ear mucosa, state of the ossicular chain, type of prosthesis. ResultsWe analyzed 153 ossiculoplasties: 96 patients presented COMWC and 57 patients presented COMC. The ossiculoplasties were performed using autologous ossicles for the most part. All ossiculoplasties were carried out in one-stage surgery. In 38% of cases ossiculoplasty was combined with mastoidectomy; in the remaining 62% of cases, ossiculoplasty was performed without mastoidectomy. Ossiculoplasty was successfully achieved in 113 patients (74%). The presence of the stapes superstructure and normal mucosa were significant predictive factors of surgical success. ConclusionThe majority of the ossiculoplasties improved hearing status satisfactorily. Multivariate analysis should be performed to investigate prognostic factors of favorable short-term hearing outcomes after ossiculoplasty. Better knowledge of these predictive factors may contribute to the surgeon's judgment and the information given to patients.

Ossiculoplasty: a prospective study of 80 cases.

The use of ossicular graft material in ossicular chain reconstruction has significantly improved hearing results hearing after tympanoplasty and tympanomastoid surgery for chronic otitis media. Today, otologists have a wide array of tools from which to choose, but may find it difficult to know which middle ear implant works best. A prospective study of 80 patients who underwent ossiculoplasty was performed in the ear, nose, and throat (ENT) department at a tertiary health care facility from 2011 to 2013. Patients with chronic suppurative otitis media with an air-bone gap (ABG) of >25 dB with ossicular involvement were included in the study. Total ossicular replacement prosthesis (TORP), partial ossicular replacement prosthesis (PORP), and refashioned incus were used. Success was defined as ABG <25 dB on postoperative Day 90. The majority patients were of middle age with moderate conductive hearing loss. Incus was the most susceptible ossicle. Overall success rate in this study was 80.0% with an average change of 15.76 dB in ABG. With continuing advances in our understanding of middle ear mechanics, the results of ossiculoplasty are improving and results can be very rewarding in experienced hands. Severity of preoperative ear discharge, preoperative mastoid cellularity, presence of disease, and surgical procedure proved to be significant prognostic factors. Autograft incus and PORP fared better when the malleus handle was present while TORP gave better results when the malleus handle was eroded.

A comparative study of surgical outcomes of ossiculoplasty using biomaterials and autologous implants

Objective: To determine amongst biomaterials (Teflon and Silicon) and autologous materials (autologous incus and cartilage), the one which give the best results of ossiculoplasty, in terms of increase in hearing sensitivity including cost effectiveness. Methods: Study was conducted in Era’s Lucknow Medical College &amp; Hospital, Lucknow, India. Randomized prospective crossover study with eighteen months follow up. 80 patients of Chronic Suppurative Otitis Media (CSOM) were randomly assigned for ossiculoplasty using biomaterials (Teflon and silicon) and autologous materials (bone and cartilage ). Surgical outcome was compared for all the four types of implant material used, in terms of increase in hearing sensitivity, extrusion rate, cost effectiveness. Pre-operatively all patients had a pure tone audiogram with a four frequency average (0.5/1/2/4 kHz) calculated for both air conduction and bone conduction. Post-operatively a pure tone audiogram using (0.5/1/2/4 kHz) was performed at 18 months follow-up. Results: Mean hearing gain (change in A-B gap) was 20.80±7.08 dB in autologous group and 19.93±7.27 dB in biomaterials. Hearing Success Rate-It indicates, total no. of patients, whose postoperative AB Gap (calculated at 500Hz,1,2,3 KHz) is equal to or less than 20 dB. In the present study the overall hearing success rate at follow up period of 4 months is 78.8%. For autologous implants it is 80% and for biomaterials it is 77.5%. Conclusion: The study concluded that there is no significant difference in improvement in AB gap, extrusion rate of implant and overall success rate between biomaterials (Teflon, silicon) and autologous implants (autologous incus, cartilage). The only significant difference between the two groups was the cost effectiveness. Hence, it is concluded in our study that the biomaterials and autologous implants used in the study have equal overall efficacy. The autologous material requires no extra cost so it can be considered as a preferred choice of implant, in comparison to biomaterial in SAARC countries, where the majority is of poor patients. DOI: http://dx.doi.org/10.3329/bjo.v19i1.12619 Bangladesh J Otorhinolaryngol 2013; 19(1): 29-35

First experiences with a new adjustable length titanium ossicular prosthesis (ALTO)

Conclusions: The new length-adjustable titanium prosthesis can give good results in terms of hearing results in ossiculoplasty. The possibility to readjust the length intraoperatively was seen as a good feature. Objective: Hearing results of ossiculoplasty with a newly designed prosthesis in 14 patients were evaluated. The prosthesis is designed to allow adjustment of length in situ. Methods: A retrospective pilot study was carried out, comparing the preoperative and postoperative audiological and clinical results with an age- and pathology-matched group. The setting was the Department of Otolaryngology at the University of Heidelberg Medical Center, a tertiary referral center. In all, 14 patients underwent tympano-ossiculoplasty in which autologous reconstruction was not an option. The ossiculoplasty was performed as a therapeutic measure with the new titanium prosthesis. We evaluated the air–bone gap closure as established from preoperative and postoperative audiograms. We also looked at the clinical aspect of the tympanic membrane. Results: The average air–bone gap came to a closure within 15 dB in 43% of the cases (6 of 14 patients). No re-perforations or extrusions of the prostheses were observed.

Role of ossiculoplasty in canal wall down tympanoplasty for middle-ear cholesteatoma: hearing results

The aim of this study was to evaluate the hearing results of ossiculoplasty in canal wall down tympanoplasty in one stage middle-ear cholesteatoma surgery. We carried out a retrospective review of a consecutive series of 142 cases which had undergone type two or three canal wall down tympanoplasty with ossicular reconstruction, between January 1995 and December 2002, due to chronic otitis media with cholesteatoma.Pre-operative audiometric testing revealed a mean air conduction pure tone average (PTA) of 50.97 dB and a mean bone conduction PTA of 22.14 dB. The mean post-operative result for air conduction PTA was 37.62 and for bone conduction PTA was 23.37 dB. The mean pre- and post-operative air-bone gaps (ABGs) were 28.83 and 13.94 dB, respectively, with a gain of 14.89 dB. Almost 62.67 per cent of patients closed their ABGs to within 20 dB. Our functional results are comparable with those of other authors. In the present study, we show that hearing improvement is possible following cholesteatoma surgery with canal wall down tympanoplasty and ossicular chain reconstruction.

Long-Term Results in Ossiculoplasty

The aim of the present study is to examine the prognostic factors based on 6-month and 5-year results of ossiculoplasty. Retrospective analysis was made on the ossiculoplasty cases in a county hospital. The information was extracted from a computer database. All patients who had ossiculoplasty were routinely followed up in a dedicated ear audit clinic on a yearly basis. Between 1988 and 1999, 242 ossiculoplasties for chronic otitis media were performed on 197 patients. Only the first ossiculoplasty operation performed on each patient during the study period was included in the analysis. The 6-month and 5-year results were analyzed. Two different statistical methods were used--logistic regression analysis and the analysis of variance (ANOVA). A successful ossiculoplasty is defined as a postoperative air-bone gap (ABG) of 20 dB or better. The overall success rate of ossiculoplasty was 66.5% at 6 months and 50.3% at 5 years. In a multivariate analysis using logistic regression, those with present malleus were 6.36 times more likely to be successful. Using ANOVA, absent malleus and otorrhea were unfavorable factors of the 6-month ABG. Using logistic regression for the 5-year analysis, malleus remained a significant predictor at 5 years. Those with malleus were 2.65 times more likely to be successful. Using ANOVA, absent malleus was the only significant unfavorable factor of postoperative ABG at 5 years. In the univariate analysis, absent stapes and revision surgery are regarded as possible unfavorable factors. In the present study, the authors try to define the studied population (chronic otitis media) and the follow-up period (6 months and 5 years), and use logistic regression and ANOVA for statistical analysis. Absent malleus and otorrhea are important unfavorable factors for short-term outcome in ossiculoplasty (6 months), whereas absent malleus is the only important unfavorable factor for long-term outcome in ossiculoplasty (5 years).

Long-Term Results of Ossiculoplasty: Reasons for Surgical Failure

To present the value of a dedicated ear audit clinic, the overall long-term results of ossiculoplasty, and the reasons for surgical failure. Retrospective analysis was performed on ossiculoplasty cases in a county hospital. The information was extracted from a computer database. Individual patient case records were reviewed in all cases of surgical failure. All patients who had ossiculoplasty were routinely followed-up in a dedicated ear audit clinic on a yearly basis. Between 1988 and 1999, the author performed 242 ossiculoplasties and their outcomes were monitored in the ear audit clinic. The 5-year results are presented. Even with the benefit of a dedicated audit clinic and a stable population, only 74.4% of ears had a known outcome at 5 years after ossiculoplasty. In the present series, 61.1% of partial and 37.6% of total ossicular reconstructions have an air-bone gap of 20 dB or better at 5 years. Of 83 identifiable late failures, 47 were caused by persistent or recurrent abnormalities within the middle ear and only 36 were thought to be caused by prosthesis-related or surgeon-related problems. The overall long-term results of ossiculoplasty have not dramatically improved in recent years, in spite of all the great advances in biomedical technologies. Unless there is a breakthrough in the understanding and management of the underlying otitis media, the long-term outcome of ossiculoplasty is unlikely to improve dramatically.