Use of incus as an interposition graft in ossiculoplasty for type IIb tympanoplasty

Authors

  • Ameya Bihani Department of ENT, KEM Hospital, Mumbai, Maharashtra, India
  • Jyoti Dabholkar Department of ENT, KEM Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.5455/2349-3259.ijct20150504

Keywords:

Incus, Ossiculoplasty, Type IIb Tympanoplasty

Abstract

Background: In cases of chronic suppurative otitis media, the most common cause for the discontinuity in the ossicular chain is erosion of lenticular or long process of incus. To study hearing results, sequel and complications of using autologous incus as interposition graft in type IIb osiculoplasty.

Methods: We studied 30 patients who required ossiculoplasty using autologous incus. The pre-operative audiograms were done. Post operatively patients were followed up to 2 years during which complete otological examination with audiogram was done.

Results: According to the American Academy of Otolaryngology-Head and Neck Surgery guidelines, a successful hearing result is the one with post-operative air-bone gap of 20 decibels or less. Hence, by this standard our success rate is 77 percent and in all of our patients we have air-bone gap closure to below 30 decibles. Average closure in air-bone gap (gain) in our patients is 25.9 decibles with average pre-operative and post-operative air-bone gap being 47.70 decibles and 16.9 decibles there was no extrusion of incus. 3 patients had residual perforation and 2 patients had retracted grafts. All the patients with retracted grafts or residual perforation had oedematous middle ear mucosa and Eustachian tube dysfunction and high MER index.

Conclusions: Autologous incus is an excellent interposition graft for ossiculoplasty. There is no risk of transmission of disease and no extra cost involved. Higher values of Middle Ear Risk Index, oedematous middle ear mucosa and Eustachian tube dysfunction are poor prognostic factor for success of ossiculoplasty.

References

Bauer M. Ossiculoplasty: autogenous bone grafts, 34 years experience. Clin Otolaryngol Allied Sci. 2000;25(4):257-63.

Rondini-Gilli E, Mosnier I, Julien N, Gouin JM, Aïdan P, Rufat P, et al. Predictive factors of outcome in 220 ossiculoplasties in adults. Ann Otolarygol Chir Cervicofac. 2001;118(5):283-90.

Dornhoffer JL, Gardner E . Prognostic Factors in Ossiculoplasty: A stastical staging system. Otol Neurotol. 2001;22(3):299-304.

Manning SC, Cantekin EI, Kenna MA, Bluestone CD . Prognostic value of eustachian tube functions in pediatric tympanoplasty. Laryngoscope 1987;97(9):1012-6.

Kumar N, Madkikar NN, Kishve S, Chilke D, Shinde KJ. Using middle ear risk index and et function as parameters for predicting the outcome of tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2012;64(1):13-6.

O'Reilly RC, Cass SP, Hirsch BE, Kamerer DB, Bernat RA, Poznanovic SP. Ossiculoplasty using incus interposition: hearing results and analysis of the middle ear risk index. Otol Neurotol. 2005;26(5):853-8.

Li HZ, Gong SS. Observation of bridging operation by an autogenous incus in the ossiculoplasty. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2008;43(10):746-50.

Naragund AI, Mudhol RS, Harugop AS, Patil PH. Ossiculoplasty with autologous incus versus titanium prosthesis: A comparison of anatomical and functional results. Indian Journal of Otology 2011;17(2):75-9.

Nikolaou A, Bourikas Z, Maltas V, Aidonis A. Ossiculoplasty with the use of autografts and synthetic prosthetic materials: a comparison of results in 165 cases. J Laryngol Otol. 1992;106(8):692-4.

Ceccato SB, Maunsell R, Morata GC, Portmann D. Comparative results of type II ossiculoplasty- incus transposition and titanium PORP. Rev Laryngol Otol Rhinol (Bord). 2005;126(3):175-9.

Downloads

Published

2015-05-01

Issue

Section

Original Research Articles