A new double-cartilage block ossiculoplasty: long-term results

Abstract

Objectives: To determinate whether ossicular chain reconstruction performed with modified double-cartilage block (DCB) ossiculoplasty used by authors, leaving the intact perichondrium layer on the cartilage surface in contact with tympanic membrane, results in significant hearing results and prevents DCB displacement and DCB loss of stiffness when compared with the original DCB technique described by Luetje and Denninghoff.

Materials and methods: Sixty-five ossicular reconstructions using DCB ossiculoplasty were performed from 1996 to 2001 in the whole study group. Eight patients had an inadequate follow-up and were excluded from the study. In the first 25 cases, the original DCB ossiculoplasty technique described by Luetje and Denninghoff was performed (Group 1). In the second group, 32 modified DCB ossiculoplasties were performed. The same author performed all cases. The main follow-up for the whole study group was 7 years. Audiometric data were calculated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery guidelines.

Main outcome measures: Mean postoperative air-bone gap closure to less than 20 dB, incidence of DCB displacement from tympanic membrane, and incidence of loss of DCB stiffness.

Results: Comparison data of hearing results, incidence of DCB slippage, and incidence of DCB loss of stiffness in the group performed with original technique and in the group with modified technique showed statistical significance. Successful rehabilitation (pure-tone average air-bone gap <20 dB) of conductive hearing loss was obtained in 48% of cases in Group 1 (original DCB) and in 81.2% of cases in Group 2 (modified technique). In the group with original DCB ossiculoplasty, the displacement of implant and its loss of stiffness occurred more often than in the second group.

Conclusion: The modified DCB represents an excellent partial ossicular replacement prosthesis. The perichondrium layer left attached on the cartilage surface in contact with tympanic membrane increases the stability of DCB and prevents the displacement and the loss of stiffness of the cartilage. The modified DCB ossiculoplasty is easy to perform. Hearing results are satisfactory and lasting. The cost is null, and the tolerance is excellent.