​Post-operative Auditory Gain in Patients Undergoing Intact Canal Wall Mastoidectomy and Ossiculoplasty with Primary Malleus Transposition (Rotation) Ossiculoplasty

ABSTRACT

Background: The absence of the long process of the incus with or without the absence of the stapes superstructure accountsfor >80% of the ossicular deformities encountered during surgery for chronic suppurative otitis media. Instead of using variousinterposing prosthesis in vogue to simplify ossicular reconstruction, to reduce time and cost, and to improve functional outcomesby retaining the catenary lever function of the handle of malleus, malleus is used by repositioning it. The present study evaluatesauditory gain after 1-year post-operative follow-up.Aim of the Study This study aims to conduct audiological evaluation of patients who underwent malleus repositioningossiculoplasty over a period of 36 months.Materials and Methods: A total of 56 patients undergoing cortical mastoidectomy and ossiculoplasty in a tertiary care hospital inKerala over a period of 3 years were included in the study. Pure tone audiometry done, pure tone average (PTA) was calculatedfor the speech frequencies (500 HZ, 1000 HZ, and 2000 HZ). Air-bone gap was calculated and tabulated. Ossicular statusduring surgery was typed according to Austin[17] and Kartush[18] classification.Procedure Malleus transposition and assembly with stapes were done. All the data were tabulated and analyzed usingstandard statistical methods.Observations and Results: Among 56 patients, 29 (51.78%) were males and 27 (48.21%) were females. The mean auditorygain in PTA among all the operated patients was 24.65 ± 1.20 dB. Mean air-bone gap closure was 26.30 ± 3.10 dB.Conclusions: Malleus relocation is a safe and efficient technique for ossicular reconstruction. The ideal position of the relocatedmalleus allows easier and more stable placement of middle ear ossicular grafts or prostheses. It helps to reduce operative timeand cost and to improve functional outcomes by retaining the catenary lever function of the handle of malleus.