Ossiculoplasty with an intact stapes: superstructure versus footplate prosthesis placement

Many techniques and prostheses are used for ossiculoplasty in the various situations of ossicular chain status that the surgeon may encounter in tympanoplasty procedures. The current study seeks to determine whether any particular technique or prosthesis used by the author demonstrates superior hearing results with fewer failures.

Retrospective review.

This study retrospectively reviews a consecutive series of cases with intact stapes superstructures, with an intact malleus handle (Austin-Kartush group A) and without (Austin-Kartush group C). The ossiculoplasties were performed with either partial prosthesis techniques from the stapes superstructure to the drum, malleus, or malleus/drum (as is traditionally reported by most authors) or with less frequently advocated total prosthesis techniques from the stapes footplate to the drum, malleus, or malleus/drum.

Of cases for which 1-year postoperative air and bone hearing results were available, group A cases had significantly smaller air-bone gaps than group C cases. There was no difference in mean air-bone gaps between partial and total reconstruction within either group A or C. A few partial and total prosthesis types had low failure rates, good mean air-bone gap hearing results, and tight spread of results to recommend them in group A cases. Total reconstruction had a lower prosthesis failure rate than partial reconstruction in group C cases, although mean air-bone gap hearing results were the same.