Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2012
Method and reproducibility of a standardized ossiculoplasty technique.
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Gluth Michael B, Moore Page C, Dornhoffer John L
Аннотация
OBJECTIVE: To describe a standardized ossiculoplasty technique and to evaluate its reproducibility.
STUDY DESIGN: Retrospective review.
SETTING: Academic tertiary referral center.
PATIENTS: The first 35 consecutive patients (adults and children) that underwent ossiculoplasty between 2009 and 2010 using a standardized technique that was newly adopted by a surgeon that had previous experience only using other ossiculoplasty techniques.
INTERVENTION: Standardized technique consisted of the following: 1) reconstruction from the stapes to the malleus neck, 2) usage of standard length prostheses (2-mm partial ossicular replacement prosthesis and 4-mm total ossicular replacement prosthesis) in nearly all cases, 3) bending the prosthesis head 15 to 30 degrees according to the contour of the malleus, 4) freestanding reconstruction without packing, 5) usage of a large cartilage graft over the prosthesis head, 6) usage of a footplate stabilization prosthesis for total ossicular replacement prosthesis cases, and 7) tympanoplasty at the same stage as ossiculoplasty. The predicted postoperative air-bone (A-B) gap was calculated according to middle ear risk factors based on a scoring system developed using this technique, which was compared with the actual average postoperative A-B gap.
MAIN OUTCOME MEASURE: Predicted versus actual postoperative A-B gap.
RESULTS: Thirty cases had audiometric data available for review. The average postoperative A-B gap was 15.3 dB (range, 1-31 dB), which was not different (p = 0.9060) than the predicted value. This also was statistically better (p < 0.0001) than the preoperative A-B gap of 27.8 dB.
CONCLUSION: Short-term data suggest that this standardized technique of ossiculoplasty leads to predictable hearing outcomes and seems to be reproducible by an experienced otologist with only limited specific instruction.
STUDY DESIGN: Retrospective review.
SETTING: Academic tertiary referral center.
PATIENTS: The first 35 consecutive patients (adults and children) that underwent ossiculoplasty between 2009 and 2010 using a standardized technique that was newly adopted by a surgeon that had previous experience only using other ossiculoplasty techniques.
INTERVENTION: Standardized technique consisted of the following: 1) reconstruction from the stapes to the malleus neck, 2) usage of standard length prostheses (2-mm partial ossicular replacement prosthesis and 4-mm total ossicular replacement prosthesis) in nearly all cases, 3) bending the prosthesis head 15 to 30 degrees according to the contour of the malleus, 4) freestanding reconstruction without packing, 5) usage of a large cartilage graft over the prosthesis head, 6) usage of a footplate stabilization prosthesis for total ossicular replacement prosthesis cases, and 7) tympanoplasty at the same stage as ossiculoplasty. The predicted postoperative air-bone (A-B) gap was calculated according to middle ear risk factors based on a scoring system developed using this technique, which was compared with the actual average postoperative A-B gap.
MAIN OUTCOME MEASURE: Predicted versus actual postoperative A-B gap.
RESULTS: Thirty cases had audiometric data available for review. The average postoperative A-B gap was 15.3 dB (range, 1-31 dB), which was not different (p = 0.9060) than the predicted value. This also was statistically better (p < 0.0001) than the preoperative A-B gap of 27.8 dB.
CONCLUSION: Short-term data suggest that this standardized technique of ossiculoplasty leads to predictable hearing outcomes and seems to be reproducible by an experienced otologist with only limited specific instruction.