Hearing results after type III tympanoplasty: incus transposition versus PORP. A systematic review

Bartel, Ricardo; Cruellas, Francesc; Hamdan, Miriam; Gonzàlez-Compta, Xavier; Cisa, Enric; Domènech, Ivan; Mañós, M.

doi:10.1080/00016489.2018.1425901

Cited by 16 publications

(9 citation statements)

References 19 publications

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“…However, a heterogeneous population was intentionally included to facilitate a broad investigation of audiometric outcomes from ossiculoplasty procedures as a whole. Despite including a small and heterogeneous study population, our post‐operative ABG outcomes are similar to other published studies reporting hearing outcomes following ossiculoplasty, 15,16,24,34‐36 thus it is reasonable to speculate that other ossiculoplasty patients also have a persistent post‐operative high‐frequency ABG. Similarly, we believe a larger patient cohort may delineate some of the small but statistically significant differences between low‐ and high‐frequency conductive hearing outcomes demonstrated herein; this is an important direction for future research.…”

Section: Discussionsupporting

confidence: 84%

Do high‐frequency air‐bone gaps persist after ossiculoplasty?

Polanik

Trakimas

Castillo‐Bustamante

et al. 2020

Laryngoscope Investig Oto

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Objectives Conventional reporting of postoperative hearing outcomes utilizes a pure‐tone averaged air‐bone gap (ABG) that is biased toward low frequencies. Consequently, a high‐frequency ABG after otologic surgery may go unnoticed. In this study, we evaluate changes in low‐ and high‐frequency ABG following ossiculoplasty. Study design Retrospective review. Subjects and setting Consecutive series of patients who underwent ossiculoplasty at a single tertiary care center. Patients with pre‐ and postoperative audiograms were included. Methods Low‐frequency ABG was calculated as the mean ABG at 250, 500, and 1000 Hz. High‐frequency ABG was calculated at 4 kHz. Pre‐ and postoperative ABGs were compared. Results Thirty‐seven consecutive patients were included. Mean age at surgery was 38 years (range, 7‐77 years). Reconstruction materials included: cartilage (N = 4), hydroxyapatite cement (N = 5), and partial or total ossicular replacement prostheses (N = 20 and N = 8, respectively). Postoperatively, the mean low‐frequency ABG improved by 11.9 ± 15.1 dB (P < .0001) and the mean high‐frequency ABG improved by 5.9 ± 16.0 dB (P = .030). Low‐frequency ABG closure was significantly larger than high‐frequency ABG closure (P = .007). Mean postoperative persistent high‐frequency ABG was 22.0 ± 13.8 dB. Conclusion In this series, ossiculoplasty improved ABG across all frequencies, but greater improvements were observed at low frequencies when compared to high frequency. Current reporting standards may not identify persistent high‐frequency ABG. Additional study of the mechanisms of high‐frequency sound conduction in reconstructed middle ears is needed to improve high‐frequency hearing outcomes in ossiculoplasty. Level of evidence Level 4.

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Section: Discussionsupporting

confidence: 84%

Do high‐frequency air‐bone gaps persist after ossiculoplasty?

Polanik

Trakimas

Castillo‐Bustamante

et al. 2020

Laryngoscope Investig Oto

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“…[11][12][13][14][15][16] Also in previous study conducted by Iñiguez-Cuadra et al among 56 canal wall down patients 33 and among 37 canal wall up patients 24 had successful ABG closure of 0-20 dB. [17][18][19] In current study, totally 10 cases underwent canal wall down 6 in incus group and 4 in titanium group, one case lost follow up in titanium group. In four cases malleus was totally absent, here in 1 case, the total ossicular replacement prosthesis was used placing it between the temporalis fascia graft and mobile foot plate with cartilage cap in four cases malleus was completely present, where total ossicular replacement prosthesis was placed between malleus and foot plate of stapes in titanium group.In incus group 8 cases had malleus.…”

Section: Discussionmentioning

confidence: 65%

“…The study conducted by Bartel 17 Orfao et al showed a postoperative decrease of 11.0 dB in air-bone gap and 12.4 dB in pure-tone average was observed in titanium ossiculoplasty compared with a reduction of 4.0 dB in air-bone gap and 5.1 dB in puretone average when autologous reconstruction was used. 18 In current study, the mean pre op pure tone average in autologous incus was 52.30 dB and in titanium ossicular replacement prosthesis was 56.11dB.…”

Section: Hearing Gain Characteristicsmentioning

confidence: 96%

Comparison of hearing outcome using ossiculoplasty with autologous incus versus titanium prosthesis

Gangadaran

Muthuchitra

Nirmala

et al. 2021

Int J Otorhinolaryngol Head Neck Surg

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Background: The aim of the study is to compare the efficacy of autologous incus versus allogenic titanium prosthesis in terms of anatomical results, hearing gain after surgery, operative course and complications.Methods: This is a prospective interventional study of 20 patients out of which 10 underwent autologus incus and 10 underwent titanium prosthesis ossiculoplasties performed between April 2018 To April 2019 in Government Kilpauk medical college and hospital, Chennai after ethical clearance. The postoperative improvement of mean air-bone gap and air conduction over same frequencies between the two groups were studied. A improvement in pure tone average more than 10 dB was considered successful.Results: In current study, 10 patients underwent ossiculoplasties using titanium ossicular replacement prosthesis and 10 patients underwent ossiculoplasties using autologous incus. 5 of the patients in each group underwent canal wall up and 5 underwent canal wall down procedure. The average ABG closure was 9.30 dB in incus group and 15.22 dB in titanium group.Conclusions: Titanium ossicular prosthesis ossiculoplasties provide a significant hearing gain and are advantageous because of the easy insertion with pre-sculpted structure yet the cost is a concern. Better results were noted in canal wall up procedures more than canal wall down procedures.

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“…As well, allografting [13] , in spite of being made to be bio-compatible, is still expensive and till now, there is no solid literature agreement regarding the effectiveness of each one of allografts. Regarding the use of IT technique, Zhang et al in 2011 [1] , firstly, reported that titanium prostheses added no more benefit compared to non-titanium ones and Bartel et al [4] in 2018, secondly, concluded that IT gave comparable efficacy as PORP. We, also, here propose CBA for ossicular reconstruction in cases of moderate hearing loss.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study conducted by Baylancicek et al 2014 [3] , BC was found to be a reliable, easily available technique with results of hearing gain comparable to partial ossicular replacement prosthesis (PORP) with no significant statistical difference between both procedures. As well, Bartel et al [4] conducted a metaanalysis in 2018 and concluded that incus transposition (IT) gave comparable results to PORP especially regarding decibels gain. In the presence of difficulties in IT, cortical bone autograft (CBA) might present a good substitute.…”

Section: Introductionmentioning

confidence: 99%

Hearing results after ossiculoplasty with incus transposition, cortical bone autografting and bone cement

Beharey

Sharnouby

zayan³

et al. 2020

Egyptian Journal of Ear, Nose, Throat and Allied Sciences

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Background: This study assesses hearing results after ossiculoplasty with incus transposition (IT), cortical bone autograft (CBA) and bone cement (BC). Methods: A total of 21 patients with mild/moderate conductive hearing loss were enrolled in our study. Patients were assigned to each of the three techniques according to length of incus defect. Pre-operative and 6 months post-operative audiograms (PTA) were obtained and results of air bone gap (ABG) were statistically analyzed. Results: A total of 7 patients were included in each technique. BC ABG was decreased from 26.57 (5.06) (mean (SD)) to 10.86 (6.34) with mean gain 15.71 (5.85) For IT group, the mean for pre-ABG was 33.57 with SD 5.13, it became 15.86 (1.86) after 6 months of follow-up with 17.71 (3.40) gain. For CBA, pre-ABG mean was 35.86 (5.67) that finally became 19.14 (2.41) achieving ABG gain 16.71 (6.68). No significant statistical difference between pre-post gain in all three surgical procedures (p-value = 0.80). Regarding side effects in each technique, infections was noted in one case of IT and two cases of CBA, transient infection was found in one case of IT and CBA, and transient vertigo in one case of BC with no significant difference in adverse effects between the three group (P-value= 0.494). Conclusions: Both BC, IT and CBA are reliable techniques for ossiculoplasty with good postoperative hearing results. The choice of the proper technique depends on length of incus defects.

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Hearing results after type III tympanoplasty: incus transposition versus PORP. A systematic review

Abstract: An improvement in hearing results was observed within both groups after type III tympanoplasty. There is no difference in decibels gained between both ossiculoplasty materials, but a better closure rate (%) was observed in the PORP group.

Cited by 16 publications

References 19 publications

Do high‐frequency air‐bone gaps persist after ossiculoplasty?

Do high‐frequency air‐bone gaps persist after ossiculoplasty?

Comparison of hearing outcome using ossiculoplasty with autologous incus versus titanium prosthesis

Hearing results after ossiculoplasty with incus transposition, cortical bone autografting and bone cement

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