Closed tympanoplasty in cholesteatoma surgery: long-term (10 years) hearing results using cartilage ossiculoplasty

The aim of this retrospective study was to evaluate the long-term hearing r esults of using costal cartilage prostheses in ossicular chain reconstructi on procedures in subjects operated on for a middle eat cholesteatoma with a n intact canal wall tympanoplasty. Thirty-six patients (four with bilateral disease) followed up for 10 years who underwent an ossiculoplasty with a c artilage prostheses between January 1987 and December 1989 constituted the population studied. AII the subjects underwent a staged intact canal wall t ympanoplasty with mastoidectomy. Ossiculoplasty with total or partial chond roprosthesis was performed during the second stage. The long-term outcome w as evaluated in terms of hearing according to the guidelines of the Committ ee on Hearing and Equilibrium (1995), and in terms of complications (anatom ical and functional). In 18 patients a partial cartilage ossicular replacem ent prosthesis (PORP) was used, while in 22 a total cartilage ossicular rep lacement prosthesis (TORP) was used. In the PORP group the mean preoperativ e air-bone gap (ABG) was 22.4 dB hearing level (HL); before the second stag e the ABG was 37.9 dB HL, at 2 years it was 12.1 dB HL, at 5 years 15.3 dB HL an at 10 years 15.8 dB HL. In the TORP group the mean preoperative ABG w as 31.6 dB HL; before the second stage the ABG was 41.1 dB HL, at 2 years i t was 14.4 dB HL, at 5 years 17 dB HL and at 10 years 18.5 dB HL. In both g roups the number of cases with a postoperative ABG of < 20 dB HL remained s table (P > 0.05) over time. The failure rate was 17.5%. but only in 5% of c ases was a functional revision needed. No cases of extrusion of the prosthe ses were encountered, The use of a chondroprosthesis is associated with fun ctional results similar to those obtained by other authors. The efficacy of the prostheses remains stable civet time and is associated with a very low rate of complications and failures, In this series no extrusion occurred a nd in no case did an infectious disease develop after cartilage transplanta tion.