© Borgis - New Medicine 4/2004, s. 112-113
Henryk Skarżyński1, Paulina Młotkowska-Klimek1, Bożena Skarżyńska2, Maciej Mrówka
Ossicular chain reconstruction in a damaged incudo-stapedial joint
1International Centre of Hearing and Speech, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
Head: Prof. Henryk Skarżyński MD, PhD
2Department of Anatomy, Medical University, Warsaw, Poland
Head: Prof. Bogdan Ciszek MD, PhD
The aim of this study was to evaluate functional results of the ossicular chain reconstruction in patients with incudo-stapedial joint destruction. Discontinuity of this joint is one of the most common results of chronic infection of the middle ear. The authors assessed 573 patients who had undergone surgical treatment using autogenous and alloplastic materials. Functional results were evaluated in two patient groups: those with reconstructed anatomical continuity of the ossicular chain, and those with non-anatomical reconstructions. The authors found more beneficial results in anatomical reconstructions with alloplastic materials, especially glassionomeric cement.
Incudo-stapedial joint destruction is one of the most common causes of conductive hearing loss resulting from chronic inflammatory changes of the middle ear (1, 2, 3, 4). Retraction of the tympanic membrane in the posterior quadrants, cholesteatoma, lesions in the mesotympani, iatrogenic trauma or congenital malformations, are direct causes of discontinuity in this part of the ossicular chain (5, 6, 7). Patients requiring the joint reconstruction constitute a substantially numerous group in the material at the Department of Otorhinolaryngosurgery, the International Centre of Hearing and Speech, Warsaw; they need effective surgical methods to provide them with good functional results.
In order to assess the procedure, the authors analyzed the results obtained in a large group of patients surgically treated for conductive and mixed hearing loss.
MATERIAL AND METHOD
A total of 573 patients with incudo-stapedial joint destruction were surgically treated at the Otorhino-laryngosurgical Clinic, International Centre of Hearing and Speech, between 1999-2001. Preoperative measure-ments at the standard frequencies of 500, 1000, 2000 and 4000 Hz showed an air-bone gap ranging from 15 dB to 40 dB. Among patients with typical patterns of joint destruction without a tympanic membrane perforation or atrophy, 20% of subjects had no conductive hearing loss owing to the tympanic membrane adjoining to the stapedial suprastructure, which provided adequate sound transmission.
Two strategies were employed in the treatment which included 402 surgical operations to reconstruct damaged parts of the incus and stapes with alloplastic material (glassionomeric cement), and 171 re-constructions of the structure chains, joining the tympanic membrane and internal ear, by means of Partial Ossicular Reconstruction Prosthesis (PORP), bone plates and fragments of cartilage.
The reconstruction of the anatomical continuity of the ossicular chain consisted of the reconstruction of the incus, as well as its joining with the head of the stapedial suprastructure, or its remnants. Glassiono-meric cement was used intraoperatively. During the non-anatomical reconstructions, the PORP columella was made of various materials (remnants of stapes, glassionomeric and titanium prostheses), or the stapes was covered with bone plates and fragments of cartilage. The patients were followed up for one year postoperatively; otoscopy and audiology were performed to assess the functional results. Hearing tests were performed at 1 month, 6 months, 1 year, 2 and 3 years after the operation. To assess hearing benefits an average was established on the basis of the air-bone gap results measured for the four mentioned frequencies.
The following causes of the ossicular chain destruction within the incudo-stapedial joint were recognized intraoperatively:
– chronic otitis media with tympanic membrane retraction 209 (36.5%),
– chronic otitis media with cholesteatoma 194 (34%),
– iatrogenic trauma due to otosurgical procedures 17 (3.0%),
– congenital malformations 21 (3.7%).
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