Analysis of Clinical Characteristic of Simple Congenital Ossicular Malformation and Ossicular Chain Reconstruction under Microsopic or Otoendoscopic Tympanoplasty

By June 7, 2019

Dongdong Ren1; Meng Zhao1;Yasheng Yuan1; Jing Yu1;Fanglu Chi1
1 ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China

To study of simple congenital ossicular malformation clinical and audiological characteristics, and to discuss options to different auditory ossicles in ossicular chain reconstruction.

Study Design:retrospective case review
Patients:Ossicular chain malformations in 78 cases (82 ears) were studied ( 46 males and 32 females), aged from 6 to 57 years old (average 23.5±14.5 Y). There are four cases of bilateral conductive deafness and 74 cases of unilateral conductive deafness .
Intervention(s):We have done the transcanal exploratory tympanotomy approach under microsope(66 ears) or endoscope(16 ears).Results of preoperative audiometry showed that air-bone gap was 40.7dB of speech frequency.

Main Outcome Measure(s): Ossicular chain reconstruction was performed in 74 cases. Two cases had done the incudostapedial joint release . The average air-bone gap was 22.5dB in four weeks post-surgery.

According to Teunissen classification (1993), we divided 82 ears into four groups, including 5 ears of type I, 11 ears of  type II , 50 ears of type III, 16 ears of type IV. Intraoperative findings demonstrated deformity types including: absence of long process of incus or in connection with the stapes soft tissues, absence of suprastructure of stapes,stapes muscle attached in lenticular process or long process of incus,crura separating from footplate, patial crura of stapes, incudostapedial joint ankyloses, stapes ankylosis, and absence of suprastructure of footplate with dyplasia of the oval window. Type I -Piston(5). Type II- Piston(11). For type III,  PORP(26);  autologous incus(2);  TORP(22); incudostapedial joint release(2). Type IV had done oval window drill-out occicular reconstruction,Piston(8), TORP(2). The average air-bone gap was 22.5dB in four weeks post-surgery.

Ossicular chain reconstruction with selection of different types of artificial ossicular depending on types of ossicular chain malformations is an effective method to improve hearing and decrease air-bone gap.