[Surgical reconstruction selection and prognosis in congenital ossicular chain malformations]

Objective:Based on the anatomical characteristics and clinical manifestations of congenital ossicular chain anomalies, this study aims to establish a selection strategy for ossiculoplasty and to evaluate surgical outcomes and prognosis, as well as to provide evidence for clinical management. Methods:A retrospective analysis was performed on the clinical data from patients with congenital ossicular chain malformation who underwent surgery at the Provincial Hospital Affiliated to Shandong First Medical University between 2019 and 2025. Patients were classified according to the Teunissen classification system. Surgical approaches, including endoscopic, microscopic, and combined endoscopic-microscopic techniques were selected based on each type, and their respective efficacy and prognosis were analyzed using a postoperative air conduction threshold of ≤25 dB HL as the criterion for therapeutic effectiveness. SPSS 26.0 was used for statistical analysis. Results:A total of 45 patients（46 ears） were included. According to Teunissen classification, patients with under Type Ⅰ（1 ear）, TypeⅡ（12 ears）, Type Ⅲ（31 ears）, and Type Ⅳ（2 ears） underwent endoscopic, microscopic, or combined surgery, respectively. The overall postoperative hearing was improved. Specifically, the air-bone gap（ABG） demonstrated a significant reduction postoperatively across all types, in Type Ⅰpatients, ABG decreased from 38 dB to 20 dB; in Type Ⅱ, from（42.67±13.56） dB to（23.41±11.95） dB; in Type Ⅲ, from（44.61±10.57） dB to（20.48±8.88） dB; and in Type Ⅳ, from（57.00±7.07） dB to（21.10±15.56） dB. The overall mean speech-frequency ABG significantly improved from（44.50±11.37） dB to（21.26±9.72） dB（t=11.343, P<0.001）. Only one patient developed mild postoperative facial nerve paralysis（House-Brackmann grade Ⅲ）. A closed-loop "diagnosis-classification-treatment" pathway was preliminarily established. Conclusion:Integrating anatomical classification with clinical presentation facilitates rational surgical planning. Flexible use of endoscopic, microscopic, or combined techniques improves surgical success and hearing outcomes and offers a systematic clinical pathway for individualized treatment of congenital ossicular chain malformation.