[Is reuse of autologous ear ossicles in cholesteatoma or chronic suppurative otitis media justified?].

From the 1950s onwards ossicular bone autografts have been used to restore the middle ear sound conduction mechanism. Controversy still exists regarding the appropriateness of autologous ossicular bone grafts in chronic middle ear diseases. This communication is based on a study of 149 ossicles surgically removed from 120 patients with different ear diseases, at the Department of Otolaryngology, Head and Neck Surgery of the University of Wuerzburg. It is the object of this study to systematically investigate the histological findings in the ossicles in cholesteatoma and chronic suppurative otitis media, and also to try to assess their significance. For comparison the ossicles of traumatic subluxation and otosclerosis are also included in our material. In about one-fourth of the incidences of cholesteatoma, squamous epithelium is found adherent to the ossicles with subepithelial connective tissue of varying thickness separating the matrix from the involved ossicle so that the matrix is never in direct contact with the underlying bone. Osteomyelitis is shown in both groups. Bone resorption predominates in the complicated metaplastic process due to the action of osteoclasts irrespective of the cholesteatoma group or the chronic otitis media group. Bone erosion is evident not only on the surface of the ossicles but also in the bone. On the other hand, ossicles in the groups of traumatic subluxation and otosclerosis remain histologically normal without evidence of pathologic changes. On the basis of these histological observations and on account of the high probability of adherent squamous epithelium in our opinion autologous ossicles from cholesteatoma and chronic suppurative otitis media should not be used in reconstructive middle ear surgery.