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Review
. 2015 Oct;35(5):338-42.
doi: 10.14639/0392-100X-590.

Cartilage ossiculoplasty in cholesteatoma surgery: hearing results and prognostic factors

N Quaranta  1 , S Taliente  1 , F Coppola  1 , I Salonna  1
Affiliations
Review

Cartilage ossiculoplasty in cholesteatoma surgery: hearing results and prognostic factors

N Quaranta et al. Acta Otorhinolaryngol Ital. 2015 Oct.

Abstract
in English, Italian

Cartilage tympanoplasty is an established procedure for tympanic membrane and attic reconstruction. Cartilage has been used as an ossiculoplasty material for many years. The aim of this study was to evaluate hearing results of costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for middle ear cholesteatoma and to determine the presence of prognostic factors. Candidates for this study were patients affected by middle ear cholesteatoma whose ossicular chain was reconstructed with a chondroprosthesis. 67 cases of ossiculoplasty with total (TORP) or partial (PORP) chondroprosthesis were performed between January 2011 and December 2013. Follow-up examination included micro-otoscopy and pure tone audiometry. The guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology Head and Neck Surgery were followed and pure-tone average (PTA) was calculated as the mean of 0.5, 1, 2 and 4 kHz thresholds. Statistical analysis was performed with ANOVA tests and regression models. Average air-bone gap (ABG) significantly improved from 39.2 dB HL (SD 9.1 dB HL) to 25.4 dB HL (SD 11 dB HL) (p < 0.001). Linear regression analysis showed that the only prognostic factor was the type of operation (p = 0.02). In fact, patients submitted to ICWT presented better post-operative ABG compared to CWDT. None of the other variables influenced the results. The present study proposes costal cartilage as material of choice when autologous ossicles are not available. The maintenance of the posterior canal wall was the only prognostic factor identified.

La cartilagine è comunemente utilizzata per la ricostruzione della membrana timpanica e dell'attico in corso di timpanoplastica. Nella nostra esperienza la cartilagine costale omologa è stata utilizzata per molti anni per la creazione di protesi ossiculari. Scopo di questo studio è stato quello di valutare i risultati funzionali dell'ossiculoplastica con condroprotesi e di identificare fattori prognostici. Abbiamo valutato pazienti affetti da otite media cronica colesteatomatosa la cui catena ossiculare è stata ricostruita mediante condroprotesi. 67 soggetti sono stati sottoposti a ossiculoplastica totale (TORP) o parziale (PORP) tra gennaio 2011 e dicembre 2013. Per la valutazione dei risultati uditivi sono state utilizzate le Linee Guida della "Committee on Hearing and Equilibrium" dell'American Academy of Otolaryngology Head and Neck. L'analisi statistica dei risultati è stata eseguita con test ANOVA e modelli di regressione lineare. Il gap via aerea-via ossea (ABG) migliorava significativamente dopo ossiculoplastica da 39,2 dB HL (DS 9,1 dB HL) a 25,4 dB HL (DS 11 dB HL) (p < 0,001). L'analisi statistica ha dimostrato che l'unico fattore prognostico è stato il tipo di tecnica chirurgica utilizzata. Infatti, i pazienti sottoposti a timpanoplastica chiusa hanno presentato miglior ABG postoperatorio rispetto alla timpanoplastica aperta (p = 0,02). Tutte le altre variabili analizzate non hanno influenzato i risultati uditivi. La cartilagine costale è il nostro materiale scelta per la creazione di protesi ossiculari quando gli ossicini autologhi non sono disponibili. La tecnica chirurgica (timpanoplastica chiusa) si è dimostrata quale unico fattore prognostico positivo.

Keywords: Cholesteatoma; Ossicular Prosthesis; Ossiculoplasty; Surgery.

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Figures

Fig. 1.
Fig. 1.
T-shaped partial ossicular replacement prostheses.
Fig. 2.
Fig. 2.
T-shaped total ossicular replacement prostheses.
Fig. 3.
Fig. 3.
Percentage of patients with different air-bone gap according to the technique used. CWDT: canal wall down tympanoplasty; ICWT: intact canal wall tympanoplasty.
See this image and copyright information in PMC

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