Learning Objectives: 1) To clarify the goals of tympanomastoid surgery 2) To present a single surgeon's 12 year cohort of patients 3) To determine hearing outcomes in patients with an isolated, intact, mobile stapes and aerated tympanum following tympanomastoid surgery 4) To compare the outcomes of Type III cartilage tympanoplasty with published results of various ossicular prostheses in similar patient groups. 5) To recommend management guidelines for hearing preservation in patients with an isolated, intact, mobile stapes
Introduction: The goals of tympanomastoid surgery are the elimination of disease and the preservation of good hearing function. There is much literature on this topic, and it is understood that a mobile stapes and aerated tympanum are essential for a successful type III tympanoplasty, and that the interposition of a cartilage disc between stapes and tympanic membrane graft can improve audiometric results. However, there is heterogeneity amongst reported case series, and conflicting reports regarding the use of ossiculoplasty materials. The aims of this paper were to analyse hearing outcomes from a 12 year cohort of patients with an isolated, intact, mobile stapes following tympanomastoid surgery; to compare primary cartilage reconstruction with no primary reconstruction, and to compare the outcomes of Type III cartilage tympanoplasty with published results of other reconstruction methods.
Methods: The records of 160 patients from a single surgeon's 12-year cohort were retrospectively analysed. Postoperative changes in air conduction thresholds (0.5, 1, 2 and 4kHz and average gains) and air-bone gap were calculated for each operated ear 2 years after surgery according to AAO-HHS guidelines. Revision surgery and other complications were documented.
Results: Audiometric and other outcomes are presented in detail
Conclusions:
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1. The vast majority of patients in whom primary reconstruction was not performed did not require further surgery, as the development of a natural Type III tympanoplasty preserved or improved hearing thresholds following primary disease elimination.
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2. Type III cartilage tympanoplasty is an effective technique for hearing improvement in patients with an intact, mobile stapes. Results are similar to those obtained with partial ossicular replacement prosthesis and autologous bone ossiculoplasty, and have the added benefits of lower cost and a lower complication rate.
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3. Our recommmendations for management of isolated stapes are based on these results.
