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Long-Term Hearing and Functional Outcomes and Complications after Ossiculoplasty

Presenting Author: Matthew Cox

Published online by Cambridge University Press:  03 June 2016

Matthew Cox ,
James Russell  and
John Dornhoffer
Matthew Cox
Affiliation:
University of Arkansas for Medical Sciences
James Russell
Affiliation:
University of Arkansas for Medical Sciences
John Dornhoffer
Affiliation:
University of Arkansas for Medical Sciences
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Abstract

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Learning Objectives: To review hearing results, long-term outcomes, and complications after ossiculoplasty.

Patients: 464 patients (3-88 years of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts, retrograde mastoidectomy with canal wall reconstruction or mastoid obliteration techniques between 1998 and 2012. All patients had at least 1 year of clinical follow-up.

Outcome Measures: Early and late audiometric outcomes, rate of successful air-bone gap closure and tympanic graft healing, and incidence of long-term complications.

Results: Hearing results were assessed in all patients with 1 year of longer of audiometric follow-up. There was no significant difference between adults and children for early hearing results (average post-op PTA-ABG [pure tone average air-bone gap] was 18.2 dB vs. 19.6 dB, respectively; p = 0.306), late hearing results (average final PTA-ABG was 18.6 dB vs. 19.4 dB, respectively; p = 0.439), or rate of air-bone gap closure to less than 20 dB (63.1% vs. 58.0%, p = 0.282). Complications were assessed in patients with 5+ years of clinical follow-up. Smoking was not found to have a significant impact on hearing results, but smokers had a significantly increased incidence of complications, as compared to non-smokers (34.7% vs. 14.0%, respectively; p = 0.0003). Revision surgeries were required in 10.3% of patients, and half of these revisions occurred more than 5 years after the initial surgery.

Conclusions: In uncomplicated cases, hearing results remain stable in the long term following ossiculoplasty. Failures of ossiculoplasty, complications and recurrence of conductive hearing loss may occur at any time, with half of revisions occurring more than 5 years after the initial surgery.