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

To determine the impact of modifiable surgical factors on ossiculoplasty outcomes after controlling for ear environment risk.

Multi-institutional retrospective review.

Six tertiary care centers from 2011 to 2019.

Adults and children.

Ossiculoplasty, including synthetic ossicular replacement prosthesis, autograft interposition, bone cement repair, and mobilization.

Correlation between modifiable surgical factors and pure-tone average air-bone gap (ABG) at most recent audiogram after controlling for preoperative risk using the statistically validated Ear Environment Risk (EER) score.

A total of 1,679 cases were included with a median follow-up time of 20 months (IQR, 5-51). After controlling for EER score, malleus engagement of prosthesis yielded favorable ABG versus direct contact to tympanic membrane without malleus engagement (beta = -2.4 dB [-3.8, -1.1], p  < 0.001). For total ossicular replacement prostheses (TORP), use of a footplate prosthesis yielded favorable ABG as compared with no footplate prosthesis (-3.6 dB [-6.1, -1.1], p  = 0.005). For synthetic prostheses, polyethylene prostheses had a less favorable ABG compared with full titanium or titanium with hydroxyapatite prostheses ( p  < 0.05). In cases where the malleus was not engaged in reconstruction, amputation of the malleus head yielded worse ABG (+3.9 dB [1.2, 6.7], p  = 0.005). There was no significant difference ( p  > 0.05) in ABG for single-stage versus multistaged approach, use of a cartilage cap over the prosthesis versus no cartilage, use of bone cement to secure a PORP to the stapes versus no cement, mastoid cavity obliteration versus no obliteration, and incudostapedial joint reconstruction with joint prosthesis/bone cement versus synthetic PORP.

With statistical correction for ear environment risk, several modifiable surgical factors are noted to impact ossiculoplasty hearing outcomes.

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