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- Title
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.
- Authors
Martin, T. P. C.; Weller, M. D.; Kim, D. S.; Smith, M. C. F.
- Abstract
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.
- Subjects
UNITED Kingdom; RETROSPECTIVE studies; MALLEUS (Ear); HEALTH outcome assessment; EAR ossicles; PREVENTIVE medicine; DISEASES
- Publication
Clinical Otolaryngology, 2009, Vol 34, Issue 3, p218
- ISSN
1749-4478
- Publication type
Article
- DOI
10.1111/j.1749-4486.2009.01929.x