Cartilage Ossiculoplasty from Stapes to Tympanic Membrane in One-Stage Intact Canal Wall Tympanoplasty for Cholesteatoma

Abstract

Original Article INTRODUCTIONThe double cartilage block ossiculoplasty for partial ossicular reconstruction in the presence of an intact stapes was described in 1987 by Luetje and Denninghoff [1] . This technique offers several advantages-it is easy to perform, uses well-tolerated autologous materials, and has no additional cost. Despite those advantages and encouraging hearing results, this interesting ossiculoplasty technique is not very popular among otologists.For several years we have routinely used this technique at our institution, and we commonly refer to it as cartilage ossiculoplasty from stapes to tympanic membrane (COST). We decided to evaluate our results with this technique in a retrospective case-control study and to compare these to results published in studies dealing with other partial ossicular chain reconstruction techniques.To obtain a homogenous series, we selected patients having undergone a COST during a one-stage intact canal wall tympanoplasty (ICW) for cholesteatoma, even if this condition is probably one of the worst for achieving good hearing results. MATERIALS and METHODSAmong all surgical procedures performed at our institution for chronic otitis media between January 1999 and August 2006, we retrospectively selected the files of patients having undergone a COST during a primary one-stage ICW for middle ear and/or mastoid acquired cholesteatoma. We excluded ossiculoplasty procedures performed in case of chronic otitis media without cholesteatoma, canal wall-down tympanoplasties (CWD), ICW with staged ossiculoplasty, ossiculoplasties performed with other material than cartilage (incus, malleus head, hydroxyapatite, or titanium prosthesis), and cases where the stapes superstructure was missing. ICW included transcanal removal of a middle ear cholesteatoma and canal wall-up tympanoplasty.Cartilage Ossiculoplasty from Stapes to Tympanic Membrane in One-Stage Intact Canal Wall Tympanoplasty for Cholesteatoma OBJECTIVE: To report hearing results of cartilage interposition ossiculoplasty in one-stage intact canal wall (ICW) tympanoplasty for cholesteatoma with intact stapes. MATERIALS and METHODS:A retrospective study of pre and postoperative hearing status was conducted at a tertiary referral otologic center in a series of 61 patients having undergone one-stage ICW tympanoplasty for cholesteatoma with intact stapes and cartilage ossiculoplasty during the same procedure. RESULTS:In the preoperative period, the mean air conduction thresholds (AC), air-bone gap (ABG), and speech reception thresholds (SRT) were 35.3, 20.14, and 35.6 dB, respectively. Postoperatively, with a mean follow-up of 29 months, AC, ABG, and SRT were 27.8, 13.34, and 28.8 dB, respectively. Mean hearing gain was 6.8 dB and mean SRT improvement was 6.8 dB. Mean bone conduction thresholds for 1, 2, and 4 kHz remained stable after surgery (17.6 dB preoperatively vs. 18 dB postoperatively). CONCLUSION:Cartilage ossiculoplasty from stapes to tympanic membrane in one-stage ICW tympanoplasty for cholesteatoma is a safe, relia...

Tympanoplasty with an Intact Stapes Superstructure in Chronic Otitis Media

“…Studies in keeping with stapes augmentation that specify the use of cartilage report the rate of surgical “success” (post-operative ABG ≤20 dB) to range between 50 and 94% 4 ,19,22, 23 and “failure” (ABG >30 dB) of between 8.2 and 35% 4 ,19, 22 with a mean post-operative ABG of 13-23.8 dB. 19 , 22 Autologous bone is reported to give “success” of 66-77% 4 ,24- 26 and “failure” of 9-34%, 4 ,24, 25 and a mean post-op ABG of 17.5-20.3 dB. 24 , 25 “Success” is achieved when using titanium in 43.8-69.1% of cases, 23 , 27 and “failure” in 18.8%, and a mean ABG of 16.8-24.1 dB.…”