Comparison of Ossiculoplasty Outcomes Using Different Materials in the Treatment of Chronic Otitis Media

초록

Objective: This study aimed to evaluate success rates after ossicular chain reconstruction using different materials. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Four hundred forty-three participants who underwent ossiculoplasty at a tertiary medical center were included. Intervention: Ossicular chain reconstruction using five materials: autologous malleus, incus, and cortical bone, as well as Hydroxyapatite (HA) and titanium. Main Outcome Measures: Hearing data were measured 1 day preoperatively and 6 months postoperatively. Successful hearing outcomes were defined by the fulfillment of more than one of the following criteria: postoperative air-bone gap of 20 dB or less, hearing air conduction (AC) gain of 15 dB or more, or postoperative AC hearing less than 30 dB. Results: Preoperative median AC values (95% confidence interval) among participants with malleus, incus, cortical bone, HA, and titanium transplants or prostheses were 50 (39.6-54.6) dB, 51.3 (48.1-51.8) dB, 50 (45.2-52.2) dB, 56.3 (50.9-57.6) dB, and 54.3 (48.5-56.0) dB, respectively (p = 0.092). The success rates in malleus, incus, cortical bone, HA, and titanium were 53.3%, 60.3%, 51.7%, 61.6%, and 69.7%, respectively. Titanium had the highest success rate among the five materials, but the differences between the materials were not statistically significant (p = 0.283). Titanium had highest success rate among the participants with erosive stapes suprastructure or obstructed Eustachian tubes (p = 0.042 for erosive stapes suprastructure and p = 0.010 for obstructed Eustachian tubes). Conclusion: Our study demonstrated that titanium prostheses would be a good alternative for ossiculoplasty in cases wherein autologous material is unavailable, especially in association with unfavorable conditions, such as with the presence of cholesteatoma, erosive stapes suprastructure, edematous middle ear mucosa, and obstructed Eustachian tube.

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