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