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Updated: Jun 5, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Cartilage shield tympanoplasty in children: review of 268 consecutive cases
Jérôme Nevoux1, Gilles Roger, Pierre Chauvin
1UMPC, Univ Paris, France. jerome.nevoux@trs.aphp.fr
Insights
Partial ossicular chain reconstruction using autologous cartilage is a reliable technique for hearing restoration. Long-term outcomes remain stable, with preoperative air-bone gap and otitis media predicting hearing success.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Audiology
Background:
- Middle ear reconstruction is crucial for hearing restoration.
- Autologous cartilage offers a biocompatible option for ossicular chain reconstruction.
- Assessing the long-term efficacy of cartilage ossiculoplasty is essential.
Purpose of the Study:
- To evaluate the effectiveness of partial ossicular chain reconstruction using autologous cartilage.
- To analyze anatomical and audiologic outcomes of cartilage ossiculoplasty.
- To identify predictive factors for hearing outcomes in this procedure.
Main Methods:
- Prospective study of 248 children (268 ears) undergoing cartilage ossiculoplasty.
- Tragal cartilage used for interposition between stapes and tympanic membrane.
- Evaluation based on American Academy of Otolaryngology-Head and Neck Surgery guidelines, with statistical analysis.
Main Results:
- Closure of air-bone gap (ABG) to within 20 dB achieved in 62.2% of ears at 1 year.
- Mean ABG improved from 25 dB preoperatively to 18.9 dB postoperatively.
- Satisfactory anatomical results (87.3%) with no cartilage complications; stable hearing outcomes at 1 and 5 years.
Conclusions:
- Cartilage ossiculoplasty is a reliable technique for partial ossicular replacement.
- Long-term hearing outcomes are stable and satisfactory.
- Preoperative ABG and postoperative otitis media predict hearing results.
Objective:
To assess the efficacy of partial ossicular chain reconstruction using autologous cartilage.
Design:
Prospective study (April 1, 1997, through January 1, 2008).
Setting:
Tertiary academic children's hospital.
Patients:
Two hundred forty-eight children (268 ears) underwent partial ossicular chain reconstruction using a shaped block of tragal cartilage interposed between the head of the stapes and an underlay tympanic membrane reconstruction along with tragal cartilage and its perichondrium.
Main Outcome Measures:
Anatomical and audiologic results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery guidelines. χ² Tests and multivariate analysis were used for statistical evaluation.
Results:
Mean age at surgery was 10.9 years. Single-stage surgery was performed in 124 ears (46.3%) (62.9% for cholesteatomas and 32.3% for retraction pockets). Second-look patients (53.7%) included 93.8% of staged surgery. Audiometric results were available for 222 ears at 1 year and for 78 ears at 5 years. Closure of the average air-bone gap (ABG) to within 20 dB was achieved in 62.2% of ears at 1 year. The mean (SD) preoperative and 1-year postoperative ABGs were 25 (11.8) dB and 18.9 (10.3) dB, respectively. Anatomical results were satisfactory in 87.3%. No cases of extrusion, resorption, or displacement of the cartilage were encountered. No statistically significant difference was found between audiometric results at 1 and 5 years. Multivariate analysis showed a significant negative correlation between preoperative and postoperative ABGs and between postoperative otitis media with effusion and postoperative ABG (P < .05).
Conclusions:
Cartilage ossiculoplasty is a reliable technique for partial ossicular replacement. Long-term hearing outcomes remain stable and satisfactory. Preoperative ABG and postoperative otitis media are the predictive factors of the hearing outcome.
