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A clinical study of delayed reconstruction in ossicular fractures
Author(s) -
Spector Gershon J.,
Pratt Lindsay L.,
Randall George
Publication year - 1973
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1288/00005537-197306000-00001
Subject(s) - incus , medicine , ossicles , tympanoplasty , prosthesis , surgery , stapes , middle ear
Twenty‐eight patients, who underwent ossicular reconstruction one or more years after the incident trauma, were studied. The overall short‐term (one year or less) improvements were as follows: 1 . 66 percent were within 10 db of closure of the air bone gap, and 82 percent were within 20 db; 2. 85 percent had a 10 db improvement in the SRT; and 3. 60 percent had a 10 percent improvement in the discrimination scores. On long‐term (two years or more) follow‐up, the results demonstrated that: 1. 43 percent maintained a 20 db air bone gap; 2. 50 percent had a 10 db improvement in the SRT; and 3. 35 percent had a 10 percent improvement in the discrimination score. These patients are subdivided into four classes of injuries: 1. incudostapedial complex; 2. incus dislocation or trauma; 3. epitympanic trauma; and 4. middle ear fibrosis. Patients who sustained isolated incudal injuries or incudo‐stapedial injuries had the best prognosis for maintaining the hearing after reconstruction, while in the latter two classes, this was not the case. Lysis of adhesions, incus interposition and reposition methods gave un‐predictable postoperative hearing improvement. Incus replacement prosthesis and conversion to Type III tympanoplasty gave more stable audiologic results. Selected case histories are presented to demonstrate the variability of the results in each of the four classes of injury. Two concepts are stressed: 1. ossicles which have been severely traumatized, interposed, repositioned or transposed behave as autogenous grafts, and 2. the post traumatic ear is not in a static state and that surgery alters the ongoing process of healing only to a certain extent.