Impact of Modifiable Surgical Factors on Ossiculoplasty Outcomes After Controlling for Ear Environment Risk: A...

Area of Science:

• Otolaryngology
• Surgical Innovation
• Audiology

Background:

• Ossiculoplasty aims to restore hearing by reconstructing the middle ear ossicular chain.
• Surgical technique variability may influence hearing outcomes, but this is often confounded by preoperative risk factors.

Purpose of the Study:

• To evaluate the influence of modifiable surgical factors on ossiculoplasty outcomes.
• To control for preoperative ear environment risk (EER) using a validated score.

Main Methods:

• Multi-institutional retrospective review of 1,679 ossiculoplasty cases (2011-2019).
• Analysis correlated surgical factors with air-bone gap (ABG) closure, adjusting for EER score.
• Interventions included various ossicular replacement prostheses, autografts, and mobilization techniques.

Main Results:

• Malleus engagement of prosthesis significantly improved ABG compared to direct tympanic membrane contact.
• For total ossicular replacement prostheses (TORP), footplate prostheses yielded better ABG.
• Polyethylene prostheses showed less favorable ABG than titanium variants; malleus head amputation worsened ABG.

Conclusions:

• Several modifiable surgical factors demonstrably impact ossiculoplasty hearing outcomes.
• Surgical choices, such as prosthesis type and malleus engagement, are critical for optimizing results.
• Controlling for preoperative risk factors provides a clearer understanding of surgical impact.