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Long-term Outcomes of Ossiculoplasty With and Without an Intact Malleus

Page, Joshua Cody; Cox, Matthew D.; King, DeAnne; Allsopp, Tristan; Dornhoffer, John L.

doi: 10.1097/MAO.0000000000002050

Objective: To compare long-term hearing outcomes following ossiculoplasty with cartilage tympanoplasty with (M+) and without (M) the malleus present.

Study Design: Retrospective chart review.

Setting: Tertiary referral center.

Patients: One twenty-six patients (18–88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts from 1998 to 2012 with at least 5 years of documented postoperative follow-up.

Main Outcome Measures: Short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 d and 1 yr after surgery), long-term hearing results (PTA-ABG measured ≥5 yr after surgery), Ossiculoplasty Outcome Parameter Staging (OOPS) index, and complications.

Results: There were 46 patients in the M+ group and 80 in the M group. Preoperative PTA-ABG was 23.8 dB for M+ and 34.5 dB for M (p = 0.00001). Short-term postoperative PTA-ABG was 19.3 dB for M+ and 18.5 dB for M (p = 0.727). Long-term postoperative PTA-ABG was 18.2 dB for M+ and 19.6 dB for M (p = 0.500). The OOPS index was 4.11 and 6.41 for M+ and M_, respectively, (p = 0.00001). Thirteen patients (10.3%) experienced complications.

Conclusion: Our data suggest that the malleus is not statistically significant with regard to its impact on final audiometric outcome following ossiculoplasty. This has implications in our clinic, particularly in our use of the OOPS index as a prognostic tool, and will likely lead to its revision. These data may further support the coupling theory of acoustic gain and weaken the catenary lever theory.

Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Address correspondence and reprint requests to Joshua Cody Page, M.D., Department of Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham #543, Little Rock, AR 72205; E-mail:

No funding received for this work

The authors disclose no conflicts of interest.

Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company