© 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%).
Postoperative patient evaluation showed that among 402 anatomical reconstructions, long-term hearing results, with a closure of the air-bone gap, were achieved in 393 ears (97%). In 9 ears (3%), hearing results were not permanent because of a disrupted cement connection (8 ears), and an extruded prosthesis (1 ear). A normal stapedius muscle reflex was present in many cases of anatomical reconstruction, i.e. in patients with a reconstructed long crus of the incus, and connection of the incus and the joint disc at the incudo-stapedial joint. Reoperations were performed in nine patients and included reconstruction of a part of the second and/or third ossicles. In one ear, additional myringoplasty with the perichondrium was performed. Proper hearing results and closure of the air-bone gap are usually measured for four standard frequencies; in a year this may reach 15-20 dB.
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1. Kojima H., Miyazaki H., Tanaka Y., Moriyama H.: 72 cases of the auditory ossicle malformation but with normal findings in the tympanic membrane. Nippon Jibiinoka Gakkai Kaiho 1998; 101 (12):1273-1379. 2.Swartz J.D., Zwillenberg S., Berger A.S.: Acquired disruptions of the incudostapedial articulation: diagnosis with CT. Radiology 1989; 171 (3):779-781. 3.Tange R.A.: Ossicular reconstruction in cases of absent or inadequate incus, congenital malformation of the middle ear and epitympanic fixation of the incus and malleus. ORL Journal for Otor-rhino-laryngology and its Related Specialties 1996; 58 (3):143-146. 4.Wang L.F., Ho K.Y., Tai C.F., Kuo W.R.: Traumatic ossicular chain discontinuity - report of two cases. Kaohsiung Journal of Medical Science 1999; 15 (8): 504-509. 5.Karia J., Jokinen K., Seppala A.: Destruction of ossicles in chronic otitis media. Journal of Laryngology and Otology 1976; 90(6):509-518. 6.Tos M.: Pathology of the ossicular chain in various chronic middle ear diseases.Journal of Laryngology and Otology 1979; 93 (8):769-780. 7.Vartiainen E.: Changes in the clinical presentation of chronic otitis media from the 1970s to the 1990s. Journal of Laryngology and Otology 1998; 112 (11):1034-1037. 8.Lacher G.: Techniques of reconstruction of the middle ear. Revue de Laryngologie Otologie et Rhinologie 1990; (Bord) 111 (5):453-462. 9.Brackmann D.E., Sheehy J.L.: Tympanoplasty: TORPS and PORPS. The Laryngoscope 1979; 89(1):108-114. 10.Daniels R.L., Rizer F.M., Schuring A.G., Lippy W.L.: Partial ossicular reconstruction in children: a review of 62 operations. The Laryngoscope 1998; 108 (11 Pt 1), 1674-1681. 11.Gjuric M., Schagerl S.: Gold prostheses for ossiculoplasty. American Journal of Otology 1998 19(3):273-276. 12.Hashimoto S., Yamamoto Y., Satoh H., Takahashi S.: Surgical treatment of 52 cases of auditory ossicular malformations. Auris Nasus Larynx 2002; 29(1):15-18. 13.House J.W., Teufert K.B.: Extrusion rates and hearing results in ossicular reconstruction. Otolaryngology, Head and Neck Surgery 2001; 125(3):135-141. 14.Slater P.W., Rizer F.M., Schuring A.G., Lippy W.H.: Practical use of total and partial ossicular replacement prostheses in ossiculoplasty. The Laryngoscope 1997; 107(9):1193-8.