From the Guidelines
Moderate to severe conductive hearing loss (CHL) is indeed an indication for ossiculoplasty. Ossiculoplasty is a surgical procedure to reconstruct the ossicular chain in the middle ear when it has been damaged or disrupted, typically due to chronic otitis media, trauma, or cholesteatoma. The procedure is generally considered when a patient has a conductive hearing loss of 30 dB or greater that cannot be managed with hearing aids or other conservative measures.
Key Considerations
- The goal of ossiculoplasty is to restore the mechanical transmission of sound from the tympanic membrane to the inner ear by reconstructing the ossicular chain using either autologous materials (like incus remnants) or prosthetic implants such as partial ossicular replacement prostheses (PORP) or total ossicular replacement prostheses (TORP) 1.
- The decision to proceed with ossiculoplasty should be based on several factors including the degree of hearing loss, the status of the middle ear (presence of infection, adequate ventilation), and the patient's overall health and expectations.
- According to the clinical practice guideline on age-related hearing loss, CHL can be caused by various pathologies in the EAC or middle ear, including tympanic membrane perforation, middle ear effusion, cholesteatoma, or ossicular discontinuity or fixation, which can potentially be corrected with intervention 1.
Important Factors
- The procedure is most successful in a well-aerated, disease-free middle ear with an intact tympanic membrane.
- Patients should understand that while significant improvement in hearing is possible, complete restoration to normal hearing levels may not always be achievable.
- It is essential to refer patients with CHL to an otolaryngologist for further evaluation to determine the underlying cause and develop an appropriate treatment plan 1.
From the Research
Ossiculoplasty and Conductive Hearing Loss
- Ossiculoplasty is a surgical procedure used to repair or replace the ossicles in the middle ear, which can become damaged due to various conditions, leading to conductive hearing loss (CHL) 2.
- CHL indicates disease in the external auditory canal, tympanic membrane, or middle ear, and can be caused by various factors such as external canal atresia, neoplasms, myringosclerosis, middle ear anomalies, effusion, cholesteatomas, and neoplasms 3.
Indications for Ossiculoplasty
- Ossiculoplasty is indicated for patients with CHL due to ossicular chain abnormalities, which can result from either discontinuity or fixation of the ossicular chain 2.
- The procedure can be performed using autologous ossicle or cortical bone grafts, or alloplast materials, and the choice of technique depends on the causative pathology, availability of graft, and surgical experience 2.
Efficacy of Ossiculoplasty
- Studies have shown that ossiculoplasty can be an effective treatment for CHL, with significant improvements in hearing outcomes, including air-bone gap (ABG) closure to ≤20 dB 4, 5.
- The OOPS index has been found to be predictive of long-term hearing results after ossiculoplasty, and can be used to prognosticate hearing outcomes in adult and pediatric patients 5.
- A grading scale of Ear Environment Risk (EER) has been developed to assess the impact of ear environment risk factors on ossiculoplasty hearing outcomes, and can be used to generate meaningful risk groupings that correlate with postoperative PTA-ABG 6.
Moedere Sever CHL and Ossiculoplasty
- There is no direct evidence in the provided studies to suggest that moedere sever CHL is a specific indication for ossiculoplasty.
- However, ossiculoplasty is indicated for CHL due to ossicular chain abnormalities, and moedere sever CHL may be a type of CHL that can be treated with ossiculoplasty, depending on the underlying cause and severity of the condition 2.