Hearing outcomes after ossiculoplasty for cholesteatoma: A retrospective comparison of autologous versus prosthetic reconstructions.

OBJECTIVE

To compare hearing outcomes between autologous and prosthetic ossiculoplasty in patients with cholesteatoma.

PRIMARY ENDPOINT: Postoperative change in pure-tone average air-bone gap (ΔPTA-ABG) following ossicular chain reconstruction using either autologous materials (cartilage or incus interposition) or partial and total titanium prostheses.

METHODS

Analyze of 312 adult patients who underwent tympanoplasty with ossiculoplasty for COM-C between 2015 and 2023 at a French university hospital, divided into two groups: autologous reconstruction (n = 192) and prosthetic reconstruction (n = 120). ΔPTA-ABG (500-3000 Hz) was the primary outcome, with secondary endpoints including air conduction thresholds at 250-4000 Hz. Audiometric data were collected pre- and postoperatively (≥ 6 months). Univariate and multivariate linear regression analyses adjusted for confounders such as prior ear surgery, surgical approach, and operative timing.

RESULTS

No significant difference in ΔPTA-ABG was found between autologous (3.3 ± 11.6 dB) and prosthetic (4.6 ± 13.0 dB) reconstructions (p = 0.37). Frequency-specific analysis showed a significant ΔABG difference only at 250 Hz (p = 0.02). Prosthetic reconstruction demonstrated greater improvement in air conduction thresholds at 250 Hz (p = 0.04), 500 Hz (p = 0.02), and 1000 Hz (p = 0.05), while no differences were observed at higher frequencies. Preoperative thresholds were worse in the prosthetic group (p = 0.009). Multivariate analysis confirmed the absence of additional predictors of ΔPTA-ABG variance.

CONCLUSION

Despite more advanced baseline disease in the prosthetic group, autologous and prosthetic ossiculoplasty were associated with comparable air-bone gap improvement. Given the residual confounding inherent to this retrospective design, these findings should be interpreted as comparable improvement rather than as proof of equivalence between reconstruction materials.