Notched Cartilage With Incus Interposition Ossiculoplasty Combined With Cavity Obliteration: A Novel Approach: Analysis of Hearing Results in 50 Cases
Sekhar Bandyopadhyay, Arijit DasBackground:
In chronic suppurative ear disease, conductive hearing loss with ossicular chain erosion, poses a serious challenge to the otologist. To overcome this hurdle, various ossiculoplasty techniques have been developed to date. Little modifications in the ossicular reconstruction technique, combined with cavity obliteration in selected cases, can yield predictably good results.
Objective:
A) To study the hearing outcome in 50 patients of Austin group A ossicular defect, using a piece of notched autologous conchal cartilage over the stapes suprastructure, combined with incus interposition and cavity obliteration. B) To compare the results of hearing outcomes of the present study with other methods of ossiculoplasty.
Methods:
The present study includes patients who underwent ossiculoplasty for Austin classification group A ossicular defect (M+, S+, and eroded long process of incus) with radiologic evidence of bone erosion involving air cells in the tympanomastoid region, and patients with tubotympanic (safe) disease having peroperative findings of massive irreversible mucosal disease involving the mastoid antrum and aditus. The study was done at North Bengal Medical College Hospital, Darjeeling, between November 1, 2017 and October 31, 2021. Preoperative high resolution computed tomography temporal bone, pure tone audiometry (preoperative and postoperative), and histopathological examination of the diseased tissue were done in all cases. Canal wall down mastoidectomy was done in all cases. A small piece of conchal cartilage was harvested (thickness: 0.5 mm, diameter: 5 mm). A central notch was fashioned with a 0.6 mm diamond burr to accommodate the head of the stapes. The body of the incus was placed between the notched cartilage and the malleus head. Temporalis fascia was harvested and placed between the anterior part of the annulus and the mastoid cavity, covering the neo-ossicular chain. Two flaps (superiorly based and inferiorly based) with periosteum and soft tissue were used for cavity obliteration.
Results:
n = 50, male 26, female 24. Atticoantral disease: 32 cases, tubotympanic disease:18 cases. Preoperative average air-bone (AB) gap: 29.3 dB, postoperative average AB gap: 19.7 dB. Significant improvement in postoperative AB gap (mean: 19.7 dB) in comparison with preoperative AB gap (mean: 29.3 dB) with a
Conclusion:
Seventy-four percent of ossiculoplasty patients achieved a postoperative AB gap within 20 dB. This technique of ossiculoplasty with autologous cartilage and ossicle with cavity obliteration is physiological, biocompatible, and stable.