Transcanal Endoscopic Ossiculoplasty in Patients with Ossicular Chain Anomalies

By June 7, 2019

Zhaoyan Wang 1,2,3, Yongchuan Chai 1,2,3, Weidong Zhu 1,2,3, Zhihua Zhang 1,2,3, Huan Jia 1,2,3, Lingxiang Hu1,2,3, Hao Wu 1,2,3
1 Department of Otolaryngology Head & Neck surgery, Shanghai Ninth people’s Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China;
2 Ear institute, Shanghai Jiaotong University School of Medicine,Shanghai, China;
3 Shanghai Key Laboratary of Translational Medicine on Ear and Nose disease, Shanghai, China.

This study is to present the technique and outcomes of transcanal endoscopic ossiculoplasty in patients with ossicular chain anomalies.

We performed a retrospective study of 21 patients with unilateral ossicular chain anomalies. The results of preoperative auditory test (Pure-tone average, PTA) showed moderate to severe conductive hearing loss. Average air-bone gap was 49.1 dBHL. The ossiculoplasty via transcanal endoscopic approach was performed in all 21 ears.

Surgical exploration confirmed that 7 ears with stapes fixation without or with other ossicular chain anomalies were performed hearing reconstruction by fenestration of the footplate and implantation of Piston. For 4 ears with absence of incus long process, 4 ears with dislocation of incudostapedial joint, their malformations were reconstructed by partial ossicular replacement prosthesis (PORP). For 6 ears with a mobile stapes footplate which included 1 crura separating from footplate, 2 partial crura of stapes and 3 absence of suprastructure of footplate, the hearing was reconstructed by total ossicular replacement prosthesis (TORP). The results of postoperative auditory test showed that hearing improvement achieved (PTA>15dBHL) in 95.2% (20/21) and the average air-bone gap was 19.6 dBHL in two weeks post-surgery. No patients experienced a complication or a reduction in their bone conduction hearing. The chorda tympani nerve was preserved in all patients. Conversion to open approach was not necessary for any of the 21 ears performed.

Transcanal endoscopic surgery is a safe and suitable approach for the management of ossicular chain anomalies by providing excellent visualization of lesions, fasting the postoperative recovery time and preserving uninvolved anatomic structures.