[Predictive factors of outcome in 220 ossiculoplasties in adults]

To define factors predictive of outcome after ossiculoplasty in adults.

From 1992 to 1998, 220 ossiculoplasties were performed for chronic otitis media in 200 patients (100 men and 90 women), average age 53 years, age range 17 - 82 years. Ninety-four patients (47%) had not undergone prior surgery (99 ossiculoplasties) and 106 (53%) underwent revision procedures (121 ossiculoplasties). Average follow-up was 20 months. All patients were reexamined at consultations 3 and 12 months after surgery and 100 patients (50%) were reexamined at two years. The operations were classified in type II tympanoplasty when the patient presented a normal stapes (n=120), and a type III tympanoplasty when the stapes arch was absent (n=100). Perforations (n=200) were repaired by temporal aponeurosis in 160 cases (80%) and a tragal perichondrium in 40 cases (20%). The materials used included 23 incus autografts (10%), 105 hydroxyapatite composite Goldenberg prosthesis (48%), 55 all-hydroxyapatite Xomed prosthesis (25%) including 20 covered with a thinned tragal cartilage, 19 teflon Klein prosthesis (9%), 12 Ionos prosthesis (5%) and 6 Malleus prosthesis (3%). The results were analyzed from the microscopic aspect and audiometric data for frequencies 0,5 to 3 KHz.

Twenty prosthesis luxed or extruded (9%) within an average of 6 months, 15 (12.4%) after a revision procedure and 5 (5%, p<0,05) after an initial procedure. Fifteen perforations (15/200, 7.5%) occurred, 9 with temporal aponeurosis grafts (9/160, 5.6%) and 6 with perichondrium grafts (6/40, 15%, NS). The residual air-bone gap (ABG) was equal to 23 +/- 12,5 dB with 57% of ABG<20 dB at 12 months follow-up. The gain in air conduction was 14 +/- 16,5 dB and the change in air-bone gap 13 +/- 12,3 dB. Some factors could significantly improve functional results: presence of the stapes arch (n=120, p<0,05), first-intention procedure (n=99, p<0,05), and use of all-hydroxyapatite prosthesis in type II (p<0,05) or type III tympanoplasties.

Ossiculoplasty with all-hydroxyapatite prosthesis produced satisfactory results in type II or III tympaonoplasties.