Complete Malleus Removal for Cholesteatoma: A Multivariate Analysis of Ossiculoplasty Success and Residual Disease

Shapiro, Scott; Bennett, Donald R.; Wetmore, Stephen J.; Cassis, Adam

doi:10.1177/0003489417743519

Cited by 6 publications

(1 citation statement)

References 13 publications

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“… 2 It is not uncommon that the handle of malleus cannot be used in the reconstruction of the ossicular chain because it is either too far anterior for a stable assembly, destroyed by extensive disease, the tensor tendon cut, or the malleus removed in its entirety by the surgeon for adequate access to the epi/protympanum. 2 , 3 The resultant ossiculoplasty now bridges between the mobile stapes superstructure and the tympanic membrane, with or without interposing cartilage for reinforcement. Therefore, 3 major groups may be encountered:…”

Section: Introductionmentioning

confidence: 99%

Tympanoplasty with an Intact Stapes Superstructure in Chronic Otitis Media

Schlemmer

Liu

Linder³

2021

Int Adv Otol

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BACKGROUND: The objective of our study was to ascertain the functional results in terms of air bone gap (ABG) closure over 4 frequencies (0.5, 1, 2, 3 kHz) in patients with chronic otitis media (COM) that underwent tympanoplasty in the presence of a mobile stapes superstructure, and in particular excluding those cases in which the malleus was used in the reconstruction. Methods: A retrospective review of our database between January 1, 2006 and June 1, 2018 identified all cases that underwent one of 3 reconstructive options: the classic Type III tympanoplasty in an open-cavity setting; the “stapes augmentation” (SA) type reconstruction where the stapes superstructure is augmented to the drum by an interposing partial ossiculoplasty of either autologous bone, cartilage, or prosthetic material; and the use of a total articular replacement prosthesis (TORP) from the stapes footplate to the drum in the presence of an intact superstructure. Results: A total of 116 procedures in 112 patients were identified with a mean ABG reduction from 27 dB to 21 dB ( P < .05). There was no significant difference in the mean post-operative ABG result between Type III (19.21 dB), TORP+ (24.90 dB), or SA (20.94 dB) reconstructions ( P = .368). Overall, an ABG ≤ 20 dB or “surgical success” was achieved in 56% ( n = 65) of cases. Only 20% ( n = 23) of cases had “failure” or a post-operative ABG >30 dB. Conclusion: Tympanoplasty with an intact stapes superstructure in COM is expected to provide acceptable levels of surgical success. We did not identify any particular risk factors associated with improved outcome.

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Section: Introductionmentioning

confidence: 99%