Total ossicular reconstruction: The "mushroom technique"

The "Mushroom technique" is introduced in this paper as an alternative technique to reconstruct the total ossicular chain by using autologous grafts where it is not possible to use the patient's ossicles, and to seal a peri-lymphatic fistula (PLF) if present.

This non randomized retrospective study covers 18 patients aged between 26 and 72 years, operated between January 2006 and March 2012 by the same surgeon using a retro-auricular approach. There were 13 males and 5 females, 12 right ears and 6 left ears. The three ossicles were damaged in 18 patients, a PLF was associated in 3 cases, and a tympanum perforation was present in 2 ears. Postoperative follow-up period was a minimum of 6 months and up to 6.5 years. The origin of 18 patient's disease was; post traumatic in 11 patients and post removal cholesteatoma in 7 patients. The "mushroom technique" was performed for all patients. The average Air Bone Gap (ABG) of each patient was calculated (frequencies 500, 1000, 2000 and 4000 Hz) both pre and 6 months postoperatively.

There were no extrusion of the composite graft. In the three cases of PLF; the leak was sealed. And in the two ears with tympanum perforation; the perforation was closed. The average post-operative ABG is 25 dB while it was 45 dB before surgery. Average gain is 20 dB. Non sensorineural hearing loss ocurred.

This technique has several advantages: The mounting footplate-fascia-connective tissue-bone-cartilage-perichondrium-tympanum is solid and long lasting, the rate of leak closure in case of PLF is improved; This technique closes the leak, the hearing results are satisfactory, the cost of autograft is null and the tolerance is excellent. On the other hand, it might be time consuming since it is a delicate looking procedure.