Malleus handle: determinant of success in ossiculoplasty

ObjectiveThe purpose of this study is to identify prognostic factors affecting outcome in ossicular chain reconstruction (OCR).Study design and settingThis study is a retrospective case series of electronic database at an academic institution.Materials and methodsWe reviewed 209 cases of chronic supportive otitis media performed from January 2000 through December 2007 and collected demographic, clinical, audiologic, and outcome information. Univariate analyses of group differences in terms of postoperative air-bone gap (ABG) changes were evaluated by analysis of variance. Multiple regression analyses were used to examine the relationship between postoperative ABG and the independent variables.ResultsThere were 105 cases of OCR the met the inclusion criteria (44 primary and 61 revision tympanoplasties), with an average follow-up of 19 months. The diagnoses were chronic suppurative otitis media without cholesteatoma in 36 cases and cholesteatoma in 69 cases. The mean preoperative ABG was 34 ± 15 dB, and the mean postoperative ABG was 20 ± 14 dB (P < 0.001). Of the independent variables analyzed, the type of procedure (ie, OCR performed during second-look tympanoplasty vs canal wall up vs canal wall down), preoperative ABG, and status of malleus handle were predictive of the success of OCR.ConclusionsFavorable prognostic factors in OCR include smaller preoperative ABG and the presence of an intact malleus handle.