The Auditory Outcomes And Prognostic Factors For Reconstruction Of Ossicular Chain With Autologous Temporal Bone

Objective:To examine auditory outcomes in patients with chronic otitis media underwent the canal wall-down tympanoplasty type Ⅲ with autologous temporal bone; to evaluate the independent prognostic factors for hearing improvements in patients with chronic otitis media underwent the type Ⅲ canal wall-down tympanoplasty with autologous temporal bone.Methods:1. All patients admitted to the department of otolaryngology in Jinshan Hospital, Fudan University with chronic otitis media from January,2008to June,2012were reviewed retrospectively. Patients who underwent the canal wall-down tympanoplasty type III with autologous temporal bone to reconstruct the ossicular chain were enrolled.2. All the enrolled patients were followed up for3to6months after the operation. The preoperative and postoperative pure-tone thresholds of air conduction(AC), bone conduction(BC) and air-bone gaps(ABG) at five frequencies:0.25、0.5、1、2、4kHz were measured and compared.3. The patients were divided into two groups according to the postoperative ABG:the good-outcome group (the postoperative ABG decreased≥5dB) and the poor-outcome group (the postoperative ABG decreased<5dB). The univariate analysis was used firstly to select the potential predictors associated with clinical outcome. The logistic regression analysis was used to identify the independent prognostic predictors of good hearing improvement.Results:1. Ninety-two patients (ninety-two eras) were finally enrolled, and forty-seven (51.1%) were male, with the mean age of45.54±14.15years. Of the92patients, cholesteatoma accounted for78.26%(72/92) and non-cholesteatoma for21.74%(20/92).2. Significant differences (P=0.005and P<0.001, respectively) were detected between the preoperative and postoperative AC thresholds (53.39±14.47dB and46.78±17.06dB, respectively) and ABG (30.10±8.54dB and23.71±9.67dB, respectively). The preoperative and postoperative BC thresholds were of no statistically significant difference.60.7%(56/92) patients had obtained successful reconstruction of ossicular chain with the postoperative ABG less than20dB.3. The patients were divided into two groups according to the postoperative ABG:the good-outcome group (n=68) and the poor-outcome group (n=24). The independent risk factors for the hearing improvement were preoperative AC, preoperative ABG, fixation of the stapes footplate and middle ear granulation (P<0.05), while the injured ossicular chain showed a strong trends(P=0.055).Conclusions:1. The canal wall-down tympanoplasty type Ⅲ with autologous temporal bone to reconstruct the ossicular chain could obviously improve hearing results in patients with chronic otitis media.2. The reconstruction of ossicular chain with autologous temporal bone principally improved the AC, while had barely affect on the BC.3. The hearing reconstruction effects after canal wall-down tympanoplasty type Ⅲ with autologous temporal bone from low frequency to high frequency is on the decline.4. The pathophysiological status of the middle ear was the most important prognosis factor for the hearing improvement.