Advertisement

Ossiculoplasty: A Prospective Study on 50 Patients Using Various Graft Materials

  • Ghatdeep K. LambaEmail author
  • Barjinder Singh Sohal
  • Jagdish Prasad Goyal
Original Article
  • 3 Downloads

Abstract

With large number of grafts available for ossiculoplasty, choice becomes difficult. An ideal graft should be safe, easily available, cost efficient, with good hearing results, uptake and low extrusion rates. The ear nose and throat surgeon is still facing the indecision over type of graft to be selected. A prospective study was conducted in Department of Otorhinolaryngology, Rajindra Hospital, Patiala (August 2012–2014) on 50 patients 15–60 years, of either sex with ABG > 40 dB. Operative procedure planned and type of graft decided intraoperatively. Autografts included remodelled malleus, remodelled incus and tragal cartilage grafts. Synthetic (Teflon) grafts were PORP and TORP. Graft uptake/failure was noted at 1 and 3 months. PTA done at 3 months postoperatively. Net hearing gain (change in ABG) was calculated for various grafts used and analysed. Mean age was 35.26 ± 13 yrs, male and female 1:1. Most common involved ossicle was incus (100%) followed by stapes (36%) and malleus (34%). Autografts, 23, uptake in 20 (86.95%), failure 3 (13.04%) cases. Synthetic grafts, 27, uptake 18 (66.66%) and failure 9 (33.33%). ‘p’value 0.09 (non significant). Mean hearing gain, autografts 14.47 ± 6.54 dB and synthetic grafts 14.57 ± 13.12 dB. ‘p’ value 0.976 (non significant). No significant difference seen in mean hearing gain and uptake/failure of autografts and synthetic grafts. Autografts being cost effective are preferred choice.

Keywords

Ossiculoplasty Autografts Synthetic grafts Hearing 

Abbrevations

ABG

Air bone gap

AIDS

Acquired immune deficiency syndrome

COM

Chronic otitis media

CT

Computed tomography

dB

Decibel

HA

Hydroxyapetite

NS

Non significant

PORP

Partial ossicular replacement prosthesis

PTA

Pure tone audiometry

Sig

Significance

TORP

Total ossicular replacement prosthesis

Yrs

Years

Notes

References

  1. 1.
    Sataloff RT, Sataloff J (2005) The nature of hearing loss. In: Sataloff RT, Sataloff J (eds) Hearing loss, vol 3, 4th edn. Taylor & Francis Group, Abingdon, pp 25–26Google Scholar
  2. 2.
    Browning GG, Merchant SN, Kelly G, Swan IR, Canter R, Mckerrow WS (2008) Chronic otitis media. In: Browning GG, Burton MJ, Lund VJ (eds) Scott–Brown’s otrorhinolaryngology, head and neck surgery, vol 237c(3), 7th edn. Edward Arnold Publishers Ltd, London, p 3399Google Scholar
  3. 3.
    Browning GG, Merchant SN, Kelly G, Swan IR, Canter R, Mckerrow WS (2008) Chronic otitis media. In: Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, Lund VJ (eds) Scott-Brown’s otrorhinolaryngology, head and neck surgery, vol 237c(3), 7th edn. Edward Arnold Publishers Ltd, London, p 3421Google Scholar
  4. 4.
    Batti JS (2004) Ossicular discontinuity/fixation. In: Cuneyt MA, Charles DB (eds) Advanced therapy of otitis media, vol 84. Bc Decker Inc, Hamilton, p 416Google Scholar
  5. 5.
    Thapa N (2015) Ossiculoplasty: a historical perspective. Indian J Otol 21:231–232CrossRefGoogle Scholar
  6. 6.
    Chavan SS, Jain PV, Vedi JN, Rai DK, Kadri H (2014) Ossiculoplasty: a prospective study of 80 cases. Iran J Otorhinolaryngol 26(76):143–150Google Scholar
  7. 7.
    Chandrashekharayya SH, Kavitha MM, Handi P, Khavasi P, Doddmani SS, Riyas M (2014) To study the level of awareness about complications of chronic suppurative otitis media (CSOM) in CSOM patients. J Clin Diagn Res 8(2):59–61Google Scholar
  8. 8.
    Shetty S (2012) Pre-operative and post-operative assessment of hearing following tympanoplasty. Indian J Otolaryngol Head Neck Surg 64(4):37–81CrossRefGoogle Scholar
  9. 9.
    Anggraeni R, Hartanto WW, Djelantik B, Ghanie A, Utama DS, Setiawan EP et al (2014) Otitis media in indonesian urban and rural school children. Pediatr Infect Dis J 33(10):1010–1015CrossRefGoogle Scholar
  10. 10.
    Prakash R, Juyal D, Negi V, Pal S, Adekhandi S, Sharma M et al (2013) Microbiology of chronic suppurative otitis media in a tertiary care setup of uttarakhand state, India. N Am J Med Sci 5(4):282–287CrossRefGoogle Scholar
  11. 11.
    Qureshi SR, Rehman UR (2015) Demographic influences on complicated chronic suppurative otitis media. Indian J Otolaryngol 21(3):170–173CrossRefGoogle Scholar
  12. 12.
    Sujatha K, Revanasiddappa SS (2013) Clinical evaluation of effect of gandhaka taila in karnasrava with special reference to chronic suppurative otitis media. Int J Res Ayurveda Pharm 4(5):708–711CrossRefGoogle Scholar
  13. 13.
    Lasisi AO, Sulaiman OA, Afolabi OA (2007) Socio-economic status and hearing loss in chronic suppurative otitis media in nigeria. Ann Trop Paediatr 27(4):291–296CrossRefGoogle Scholar
  14. 14.
    Orji FT, Dike BO, Oji O (2015) Determinants of non-healing ear discharge in chronic suppurative otitis media in a developing country. Eur Arch Otorhinolaryngol 272:2713–2718CrossRefGoogle Scholar
  15. 15.
    Shaheen MM, Raquib A, Ahmad SM (2012) Chronic suppurative otitis media and its association with socio-econonic factors among rural primary school children of bangladesh. Indian J Otolaryngol Head Neck Surg 64(1):36–41CrossRefGoogle Scholar
  16. 16.
    Olowookere SA, Ibekwe TS, Adeosun AA (2008) Pattern of tympanic membrane perforation in ibadan: a retrospective study. Ann Ib Postgrad Med 6(2):31–33Google Scholar
  17. 17.
    Abou-Elhamd KEA, Sayed RH, Moussa AE (2007) The other ear in unilateral chronic suppurative otitis media. Saudi J Oto Rhino Laryngol Head Neck Surg 9(1):24–26Google Scholar
  18. 18.
    Kumar N, Chilke D, Puttewar MP (2012) Clinical profile of tubotympanic CSOM and its management with special reference to site and size of tympanic membrane perforation, eustachian tube function and three flap tympanoplasty. Indian J Otolaryngol Head Neck Surg 64(1):5–12CrossRefGoogle Scholar
  19. 19.
    Rai T (2014) Radiological study of the temporal bone in chronic otitis media: prospective study of 50 cases. Indian J Otol 20(2):48–55CrossRefGoogle Scholar
  20. 20.
    Olowookere SA, Ibekwe TS, Adeosun AA (2008) Pattern of tympanic membrane perforation in ibadan: a retrospective study. Ann Ib Postgrad Med 6(2):31–33Google Scholar
  21. 21.
    Elango S, Than T (1995) Mastoiditis in kelantan. Med J Malays 50(3):233–236Google Scholar
  22. 22.
    Rout MR, Das P, Mohanty D, Rao V, Susritha K, Jyothi BES (2014) Ossicular chain defects in safe type of chronic suppurative otitis media. IJOL 20(3):102–105Google Scholar
  23. 23.
    Lee DH, Jung MK, Yoo YH, Seo JH (2008) Analysis of unilateral sclerotic temporal bone: how does the sclerosis change the mastoid pneumatization morphologically in the temporal bone? Surg Radiol Anat 30(3):221–227CrossRefGoogle Scholar
  24. 24.
    Caner G, Olgun L, Gultekin G, Aydar L (2005) Local anesthesia for middle ear surgery. Otolaryngol Head Neck Surg 133(2):295–297CrossRefGoogle Scholar
  25. 25.
    Yung MW (1996) Local anaesthesia in middle ear surgery: survey of patients and surgeons. Clin Otolaryngol Allied Sci 21(5):404–408CrossRefGoogle Scholar
  26. 26.
    Jamro BU, Magsi PB, Sangi HA (2013) Intraoperative findings during canal wall down mastoidectomy in chronic suppurative otitis media (CSOM). RMJ 38(2):173–176Google Scholar
  27. 27.
    Udaipurwala IH, Iqbal K, Saqulain G, Jalisi M (1994) Pathological profile in chronic suppurative otitis media—the regional experience. J Pak Med Assoc 44:235–237Google Scholar
  28. 28.
    Yorgancılar E, Yildirim M, Gun R, Bakir S, Tekin R, Gocmez C et al (2013) Complications of chronic suppurative otitis media: a retrospective review. Eur Arch Otorhinolaryngol 270(1):69–76CrossRefGoogle Scholar
  29. 29.
    Zhu F, Zhang Q, Yu H, Zhang X, Yu A (2004) Evaluation of healing effect for simultaneously tympanoplasty in treating chronic suppurative otitis media with cholesteatoma and/or granulation tissue. Lin Chuang Er Bi Yan Hou Ke Za Zhi 18(9):547–548Google Scholar
  30. 30.
    Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D (2008) Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol 122(5):442–446CrossRefGoogle Scholar
  31. 31.
    Beutner D, Huttenbrink KB (2009) Passive and active middle ear implants. Laryngorhinootologie 88(Suppl 1):S32–S47CrossRefGoogle Scholar
  32. 32.
    Mohanty S, Gopinath M, Subramanian M, Vijayan N (2012) Relevance of pure tone average (PTA) as a predictor for incus erosion. Indian J Otolaryngol Head Neck Surg 64(4):374–376CrossRefGoogle Scholar
  33. 33.
    Rout MR, Das P, Mohanty D, Rao V, Susritha K, Jyothi BES (2014) Ossicular chain defects in safe type of chronic suppurative otitis media. IJOL 20(3):102–105Google Scholar
  34. 34.
    Gomaa MA, Abdel Karim AR, Abdel Ghany HS, Elhiny AA, Sadek AA (2013) Evaluation of temporal bone cholesteatoma and the correlation between high resolution computed tomography and surgical finding. Clin Med Insights Ear Nose Throat 6:21–28Google Scholar
  35. 35.
    Kartush JM (1994) Ossicular chain reconstruction: capitulum to malleus. Otolaryngol Clin N Am 27:689–715Google Scholar
  36. 36.
    Gaurano JL, Joharjy IA (2004) Middle ear cholesteatoma: characteristic CT findings in 64 patients. Ann Saudi Med 24(6):442–447CrossRefGoogle Scholar
  37. 37.
    Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S (2010) Ossicular chain status in chronic suppurative otitis media in adults. Indian J Otolaryngol Head Neck Surg 62(4):421–426CrossRefGoogle Scholar
  38. 38.
    Albera R, Canale A, Piumetto E, Lacilla M, Dagna F (2012) Ossicular chain lesions in cholesteatoma. Acta Otorhinolaryngol Ital 32(5):309–313Google Scholar
  39. 39.
    Garap JP, Dubey SP (2001) Canal-down mastoidectomy: experience in 81 cases. Otol Neurotol 22(4):451–456CrossRefGoogle Scholar
  40. 40.
    Bahmad F, Merchant SN (2007) Histopathology of ossicular grafts and implants in chronic otitis media. Ann Otol Rhinol Laryngol 116(3):181–191CrossRefGoogle Scholar
  41. 41.
    Pusalkar AG, Steinbach E (1992) Gold implants in middle ear reconstruction surgery. In: Yanagihara N, Suzuki JI (eds) Transplants and implants in otology, vol 2, 2nd edn. Kugler Publications, Amsterdam, pp 111–116Google Scholar
  42. 42.
    Mundada PS, Jaiswal SJ (1989) A method for ossicular reconstruction with tragal cartilage autografts. Laryngoscope 99(9):955–962CrossRefGoogle Scholar
  43. 43.
    Kawatra R, Maheshwari P (2013) A comparative study of surgical outcomes of ossiculoplasty using biomaterials and autologous implants. Bangladesh J Otorhinolaryngol 19(1):29–35CrossRefGoogle Scholar
  44. 44.
    Malard O, Daculsi G, Toquet J, Beauvillain De Montreuil C, Legent F, Bordure P (2001) Autografts versus biomaterials for ossiculoplasty with normal stapes; a comparative analysis of functional outcome in 100 cases. Ann Otolaryngol Chir Cervicofac 118(4):225–231Google Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of ENTGMC PatialaJalandharIndia
  2. 2.Department of ENTGMC PatialaPatialaIndia

Personalised recommendations