Hearing results of ossiculoplasty in Austin-Kartush group A patients.

OBJECTIVE: To compare hearing results in patients who underwent ossiculoplasty for Austin-Kartush group A impairments (incus erosion, malleus handle present, stapes superstructure present) with the results in patients with an intact ossicular chain who required only myringoplasty. The literature on hearing results of ossiculoplasty with different types of prostheses and different techniques is reviewed. PATIENTS AND STUDY DESIGN: This study retrospectively reviews a series of 181 consecutive ossiculoplasties and 204 consecutive myringoplasties. SETTING: The study was carried out partly at a private practice and partly in an academic tertiary referral center. MAIN OUTCOME MEASURES: This study complies with levels 1 and 2 of the guidelines recommended by the American Academy of Otolaryngology--Head and Neck Surgery (1995). RESULTS: When success was defined as a postoperative air-bone gap within 10 dB, the success rate was higher for myringoplasty (81%) than for ossiculoplasty (55%). When success was defined as a postoperative air-bone gap within 20 dB, the success rate was 97% in myringoplasties and 85% in ossiculoplasties. There was no significant deterioration over time of the mean postoperative air-bone gap for any frequency. CONCLUSION: Cumulative data from several authors show that -50% of patients undergoing partial ossiculoplasty have a postoperative air-bone gap of 0 to 10 dB, and 80% have a postoperative air-bone gap of 0 to 20 dB. Equally good results may be achieved with autograft (no difference was found between interposition of the incus or the head of the malleus), homograft, or alloplastic partial prostheses. With alloplastic total prostheses, 36% of patients have a postoperative air-bone gap of 0 to 10 dB, and 74% have a postoperative air-bone gap of 0 to 20 dB.