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Results of primary ossiculoplasty in ears with an intact stapes superstructure and malleus handle: inflammation in the middle ear at the time of surgery does not affect hearing outcomes
Author(s) -
Martin T.P.C.,
Weller M.D.,
Kim D.S.,
Smith M.C.F.
Publication year - 2009
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/j.1749-4486.2009.01929.x
Subject(s) - medicine , stapes , malleus , middle ear , surgery , mastoidectomy , tympanoplasty , cholesteatoma , audiology
Objective: To determine whether any factors are predictive of success or failure in primary ossiculoplasty employing autologous bone in Austin‐Kartush Group A (stapes and malleus handle present) ears. Study design: Retrospective review of a single‐surgeon case series. Setting: Two District General Hospitals in the United Kingdom. Patients: Of 135 patients undergoing primary repair, 116 had sufficient data for analysis (mean follow‐up 33 months). Main outcomes measured: Postoperative air–bone gaps (pABG) in patients with differing qualities of middle‐ear mucosa (active versus inactive), differing pathologies (mucosal versus squamous) and differing surgical procedures [canal‐wall up (CWU) versus canal‐wall down (CWD)]. Secondary outcome measure: ‘Belfast Rule of Thumb’ (operated ear hearing brought to 30 dB or better or to within 15 dB of contralateral ear). Results: Postoperative ABGs were closed within 10 dB in 37%, 20 dB in 74% at latest follow‐up. The only significant factors predicting hearing outcomes were the status of the canal wall (CWU = 14.1 dB, CWD = 24.7 dB: significant, P = 0.00) and whether surgery was primary or revision. Mean ABG was 14.7 for inactive middle ear mucosa, 17.2 for active middle ear mucosa (not significant, P = 0.25). Excluding CWD procedures from the analysis improved outcomes to 80% (within 20 dB) and 41% (within 10 dB) overall, and the mean for active and inactive ears to 14.2 and 14.0 dB respectively. Postoperatively, 82% of patients fulfilled the ‘Belfast Rule of Thumb’. Conclusion: The most significant prognostic factor affecting hearing outcomes – status of the canal wall – is independent of staging. The factor most associated with staging – the status of the middle ear mucosa – is only weakly associated with a successful functional outcome.