eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Middle Ear & Mastoid

Middle Ear, Ossiculoplasty: Follow-up

Author: Robert A Battista, MD, FACS, Assistant Professor of Otolaryngology, Northwestern University Medical School; Consulting Staff, Ear Institute of Chicago, LLC
Coauthor(s): Carlos Esquivel, MD, Consulting Staff, Department of Surgery, Neuro-Otology and Skull Base Surgery, Madigan Army Medical Center
Contributor Information and Disclosures

Updated: Feb 18, 2008

Outcome and Prognosis

The status of the tympanic membrane and middle ear has a significant influence on the prognosis of hearing outcomes in ossiculoplasty.

Hearing results typically are classified based on the postoperative air-bone gap. Classifications based on the air-bone gap are usually stratified as excellent (<10 dB), good (11-20 dB), and fair (21-30 dB). Initial hearing results may diminish with time; therefore, results should be reported at 1, 3, and 5 years.

Prosthesis extrusion has varied from 5-39% in the literature. The rate of extrusion depends on several factors, the most important of which is the status of the middle ear and eustachian tube and the implant material.

The following is a list of situations that generally have a more favorable prognosis for improved hearing compared to their anatomic counterpart:

  • Malleus handle present versus handle absent
  • Intact stapes arch versus absent arch
  • Canal wall up versus canal wall down
  • Mastoidectomy not necessary versus mastoidectomy performed

In addition, hearing results generally worsen as the number of revisions increases. The worst results typically occur in patients with congenital ossicular abnormalities.

In general, the better the air conduction and the smaller the preoperative air-bone gap, the greater the chance for a successful hearing result. Goldenberg suggests that this may be because patients with these characteristics have better eustachian tube function, healthier mucosa, and less ossicular damage compared to patients with a poor preoperative air-bone gap.7

Future and Controversies

Aeration of a mucosal-lined tympanic cavity is essential for a functioning middle ear. Extrusions of even the best-designed prostheses occur because of abnormal middle ear pathology such as atelectasis, middle ear fibrosis, recurrent cholesteatoma, tympanic membrane perforation, and otitis media.

Various polymers have been developed in an attempt to maximize prosthetic biocompatibility and ease of use, while minimizing the chance of extrusion.

In addition to biocompatibility, cost containment issues have influenced the development of ossicular prostheses. One of the greatest challenges in the future will be to define the appropriate prosthetic design for optimal sound transmission. Consideration of the prosthesis weight, head size, and footplate attachment are future research questions that must be addressed in a scientific biologic model.

Some of the controversial issues of ossiculoplasty include whether revision surgery should be advised and deciding when a hearing aid is a better option for hearing improvement. These controversies have continued for some time and will continue until implant and hearing aid technology are improved and well-controlled studies are performed.

In terms of surgical technique, each surgeon should choose the technique and prosthesis that provides the best result for his or her patients.

 


More on Middle Ear, Ossiculoplasty

Overview: Middle Ear, Ossiculoplasty
Workup: Middle Ear, Ossiculoplasty
Treatment: Middle Ear, Ossiculoplasty
Follow-up: Middle Ear, Ossiculoplasty
Multimedia: Middle Ear, Ossiculoplasty
References
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References

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Further Reading

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Keywords

ossicular chain reconstruction, autografts, homografts, alloplastic prosthetics, ossicle, high-density polyethylene sponge, HDPS, hydroxylapatite, Middle Ear Risk index, MER index, prosthesis, partial ossicular reconstruction prosthesis, PORP, total ossicular reconstruction prosthesis, TORP, ossicular reconstruction, ossiculoplasty of the middle ear, ossiculoplasty, chronic otitis media, ossicular damage, middle ear

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Contributor Information and Disclosures

Author

Robert A Battista, MD, FACS, Assistant Professor of Otolaryngology, Northwestern University Medical School; Consulting Staff, Ear Institute of Chicago, LLC
Robert A Battista, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Carlos Esquivel, MD, Consulting Staff, Department of Surgery, Neuro-Otology and Skull Base Surgery, Madigan Army Medical Center
Carlos Esquivel, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Jack A Shohet, MD, Chairman of Otolaryngology, Hoag Hospital
Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Tinnitus Association, and California Medical Association
Disclosure: Envoy Medical Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Peter S Roland, MD, Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, School of Human Development.
Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Alcon labs Honoraria Speaking and teaching; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear corp Honoraria Board membership; Med El corp travel grants Speaking and teaching; Insight vision Consulting fee Consulting

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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