An intact stapes superstructure independently predicts ossiculoplasty success: analysis of 100 titanium reconstructions.

OBJECTIVES

This study aimed to evaluate whether the presence of an intact stapes superstructure is a significant factor in the success of an ossiculoplasty. Secondary factors assessed included presence of cholesteatoma and revision surgery.

METHODS

A retrospective cohort study in a Scottish tertiary centre analysed audiological outcomes from 100 consecutive adult patients undergoing single-stage ossiculoplasty with titanium prostheses (partial ossicular replacement prosthesis; total ossicular replacement prosthesis). Patient demographics and pre- and post-surgery audiometric data were collected. Bivariate analysis and multivariate linear regression determined independent predictors of post-operative air-bone gap closure.

RESULTS

Presence of an intact stapes superstructure significantly improved air-bone gap closure (27.4 dB vs. 21.1 dB; p = 0.048), remaining independently significant in multivariate analysis (β = 9.93; p < 0.001). Larger pre-operative air-bone gap strongly predicted better closure (β = 0.87; p < 0.001). Cholesteatoma and revision status were not independent predictors.

CONCLUSION

Preservation of the stapes superstructure enhances ossiculoplasty outcomes using titanium prosthesis. Patients with larger initial air-bone gaps, especially those with an intact stapes, experience the greatest post-operative improvement.