Pathology as it relates to ear surgery. V. Ossiculoplasty

In the present state of the art, autografts and homografts behave equally well in ossiculoplasty. Allografts are to be reserved for cases in which these two are in short supply. Bone grafts, autogenous and homologous, did not show gross changes in physical characters or surface structure. No obvious remodelling occurred in the grafts eight years after their insertion in the middle-ear. Microscopically, progressive deposition of new bone occurred, resulting in narrowing of the bone lacunae and bone marrow spaces. Cartilage autografts underwent progressive ischemic calcification in the middle-ear. No evidence of erosion, dissolution or remodelling was apparent eight years after their insertion in the middle-ear. Plastipore prostheses resulted in a consistent local fibrous tissue and foreign body reaction. Micro-disintegration of the prostheses is questionable. No gross changes in the physical characters or surface structure of these prostheses was evident 34 months after their insertion in the middle-ear. Inadequate hearing results following ossiculoplasty in this series were most commonly due to loss of contact between the graft and the remaining ossicles. Eustachian tube dysfunction was another possibility. Dissolution of the grafts was not the cause in any of our cases.