Ossiculoplasty: comparison of four different methods

ABSTRACT

The use of plastipore PORP and TORP prostheses in ossiculoplasty is still a controversial issue. This study assesses their value in gearing improvement as compared to autograft and homograft ossicles. Eighty-eight patients aged 3-47 years with chronic suppurative etitis media were included in this study. Fifty-seven patients had non- cholesteatomatous otitis media and 31 had cholesteatoma. Reconstruction of the gap between the drum and stapes [type II tympanoplasty] was performed with autograft sculptured incudes in 30 patients and with PORPs in 25 patients. In drum to stapedial footplate reassembly [type III typanoplaty] homograft incuded was used in 18 patients and TORPs in 15 patients. All patients were followed up for at least one year postoperatively when the hearing was assessed. Surgery was considered successful if the patient obtained a 20 dB or less difference between pre-operative bone and post-operative air conduction in the speech frequencies. Sixty three% of patients who had undergone incus interposition [type II tympanoplasty] fulfilled this criterion. Similar success was obtained in 29% of patients with homograft incus. In type III tympanoplasty, homograft incus gave 39% success rate while TORP gave 40% success rate. In type II tympanoplasty incus interposition has given statistically better results than PORP [p 0,04] as regards hearing gain. However, in type III tympanoplasy, the difference between the results of homograft incudes and TORP was insignificant. Whenever possible incus interposition in type II tympanoplasty should be the methods of choice. In drum to footplate re-construction, TORP, however still has a place in ossiculoplasty