Physiological reconstruction of defects of the incus long process

Operations to reconstruct defects of the ossicular chain conventionally involve the creation of a link between the malleus handle or tympanic membrane and the head of the stapes. These procedures do not produce satisfactory hearing results in a significant number of patients and must be considered unphysiological. Over the last 5 years the author has been using an alternative approach for patients with defects of the long process of the incus but an intact stapes arch in which the defect is repaired with a small cortical bone graft. Because of the way in which the graft fits over the stump of the long process it is called the 'sleeve' technique. So far 30 operations have been carried out and 21 patients have been followed for more than 1 year. The hearing results in these patients have been compared with those for patients with the same ossicular defect who have undergone conventional reconstructions by the same surgeon. There were significantly larger hearing gains (P < 0.04) and smaller postoperative air-bone gaps (P < 0.04) at 1 year in the 'sleeve' technique group. The technique is easy to perform and therefore appears to be the technique of choice in ears with partial erosion of the long process of the incus.