Myringostapediopexy and myringolenticulopexy in mastoid surgery

Abstract

Objective: To compare hearing results in patients undergoing myringostapediopexy or myringolenticulopexy in canal wall down mastoidectomy.

Study design: Case series of one surgeon. A retrospective review of 83 consecutive mastoid cavity operations for primary cholesteatoma. Only those patients who had undergone either myringostapediopexy or myringolenticulopexy were included.

Setting: District general hospital.

Patients: Forty-two procedures were performed in 40 patients. The mean age was 42 years old. The average follow up was 5.9 years.

Intervention: Seventeen patients underwent myringolenticulopexy (the incus head was excised, leaving the lenticular process attached to the stapes prior to graft placement) and 25 underwent myringostapediopexy (type III tympanoplasty).

Main outcome measures: Audiometry three to six months after surgery, and status of mastoid cavity after a minimum follow up of one year.

Results: Comparison of post-operative hearing results for the two groups showed a statistically significant hearing advantage for myringolenticulopexy (p = 0.029). In the myringolenticulopexy group, 92 per cent achieved a post-operative air-bone gap of less than 30 dB, compared with 62 per cent in the myringostapediopexy group. The mean post-operative air-bone gaps in the two groups were 17.5 and 24.7 dB, respectively.

Conclusion: When surgically feasible, the technique of myringolenticulopexy is a useful method of preserving serviceable hearing in single-stage mastoid cavity surgery.