From the Guidelines
Ossiculoplasty is indicated for patients with conductive hearing loss caused by ossicular chain disruption or fixation, as evidenced by CT temporal bone imaging, which is the first-line imaging modality for evaluating the external auditory canal, ossicular chain, and inner ear structures. The primary candidates for ossiculoplasty include patients with chronic otitis media with ossicular erosion, traumatic ossicular discontinuity, congenital ossicular abnormalities, or otosclerosis that has failed stapedectomy 1.
Key Considerations
- The procedure aims to restore the sound transmission mechanism by reconstructing the ossicular chain using either autologous materials (incus, cartilage) or prosthetic implants (PORP for partial or TORP for total reconstruction).
- Timing is crucial, with the middle ear should be disease-free for at least 3-6 months before surgery, with intact tympanic membrane or simultaneous tympanoplasty planned.
- An air-bone gap of at least 20-30 dB on audiometry typically justifies surgical intervention.
- The success of ossiculoplasty depends on multiple factors including middle ear aeration, eustachian tube function, and status of the remaining ossicular structures, particularly the stapes footplate and superstructure.
Diagnostic Evaluation
- CT temporal bone imaging is essential for evaluating the ossicular chain and identifying changes such as otospongiosis (otosclerosis), ossicular erosion or fusion, round window occlusion, and dehiscence of the superior semicircular canal 1.
- The use of bone windows is necessary to visualize the details of temporal bone morphology, and intravenous (IV) contrast is not beneficial for evaluation of temporal bone in patients with conductive hearing loss 1.
From the Research
Ossiculoplasty Indications
- Ossiculoplasty is indicated for patients with chronic suppurative otitis media with an air-bone gap (ABG) of >25 dB and ossicular involvement 2
- The procedure can be considered for patients with severe-to-profound hearing loss, particularly those with a low ossiculoplasty outcome parameter staging (OOPS) score, aerated middle ear, or no soft tissue density of the retrotympanic space on CT 3
- Ossiculoplasty is also indicated for conductive hearing loss resulting from ossicular chain abnormalities, such as discontinuity or fixation of the ossicular chain 4
- The procedure can be performed in patients with intact tympanic membranes and lesions limited to the ossicular chain 5
Patient Selection
- Patients with chronic otitis media, severe-to-profound hearing loss, and high bone conduction threshold may benefit from ossiculoplasty 3
- Those with a high OOPS score, obstructed Eustachian tube, or sclerotic mastoid or soft tissue density of the retrotympanic space on CT may have poorer outcomes 3
- Patients with otosclerosis, tympanosclerosis, cholesteatoma of the middle ear, chronic suppurative otitis media, or tumor of the middle ear may be excluded from ossiculoplasty 5
Surgical Considerations
- The choice of technique and graft material depends on the causative pathology, availability of graft, and surgical experience 4
- Autologous ossicle or cortical bone grafts are considered the gold standard due to their biocompatibility, stability, and ability to yield optimal sound transmission 4
- Ossiculoplasty can be performed under oto-endoscope, with good efficacy and minimal complications 5