Autologous Ossicular Grafts in One-Stage Surgery for Chronic Otitis Media

Abstract

Objectives: One hundred thirty-four (134) patients who underwent one-stage surgery for chronic otitis media using autologous

ossicular grafts were evaluated to determine functional hearing outcomes.

Method: Records of 134 patients who underwent one-stage surgery for chronic otitis media in an otologic practice at a university

tertiary hospital from December 1987 to December 2003 were evaluated.

Results: Approximately 52% were males and 48% were females, with 140 ears evaluated. One hundred sixteen (116, 83%) had

primary surgery and 24 (17%) had previous surgeries. Cholesteatoma was seen in 82 (58%), and not in 58 (18%) (with 24 dry ears and

34 discharging ears). Canal-down mastoidectomy was performed in 98 patients (70%) as opposed to 42 (30%) with canal-up procedure.

One third (33.86%) had postoperative air-bone gap (ABG) of less than 10 dB while more than 50% of cases had 20 dB or less average

postoperative ABG at 0.5, 1, 2 and 4 kHz frequencies. However, about one fourth of cases (27%) had worse mean postoperative ABG.

In general, a postoperative ABG of 10 dB was noted more frequently in cases with intact superstructure than those without stapes

superstructure across the four frequencies. Most common complications included recurrent ear discharge, epithelial cyst formation, and

tympanic membrane graft perforation.

Conclusion: One-stage surgery for chronic otitis media using autologous tissues is a reasonable alternative to accomplish the dual

aims of tympanoplasty. The complication rate is low while postoperative hearing results are not markedly different from results obtained

with two-stage procedures. Canal-down or canal-up mastoidectomy may both be carried out depending on the nature of the pathology

without prejudice to the short term postoperative hearing results. Simplified ossicular connection may be done to connect the stapes

with either the malleus or the tympanic membrane graft to improve hearing. Improvements in procedures and techniques should be

aimed not only to eradicate disease and improve hearing but also to avoid further injury to the cochlea.