CHANGING TRENDS IN OSSICULOPLASTY: HISTORICAL EVOLUTION OF MATERIALS AND TECHNIQUES TO CONTEMPORARY CONCEPTS IN MIDDLE EAR RECONSTRUCTION”

Abstract

Background: Ossiculoplasty is a key surgical procedure for reconstructing the ossicular chain disrupted by chronic suppurative otitis media (CSOM) with or without cholesteatoma, aiming to improve conductive hearing loss. The present study evaluated 74 patients undergoing various ossiculoplasty procedures (Type I–IV, including all Type II subtypes) to compare demographic, clinical, and audiological outcomes, and subjective satisfaction using the CSOM Outcome Score-15. Methods: Seventy-four adult patients (age range 18–65 years) with CSOM undergoing ossiculoplasty from [insert study period] were prospectively enrolled. Variables assessed included age, gender, duration of CSOM, presence of cholesteatoma, ossicular disruption staging (Wullstein classification), pre- and postoperative audiological evaluation (pure-tone average [PTA] and air-bone gap [ABG]), surgical procedure undertaken, postoperative hearing outcomes, and patient-reported satisfaction measured by CSOM Outcome Score-15. Audiological and satisfaction scores were compared across ossiculoplasty types (I–IV). Results: The mean age was 38.7 ± 12.4 years with a male:female ratio of approximately 1:1.1. CSOM duration averaged 7.2 ± 3.5 years, and cholesteatoma was present in 46% of cases. Ossicular chain disruption staging showed the highest frequency of incus erosion and absence of malleus. Type II procedures (all subtypes) constituted the majority of reconstructions, followed by Type III and Type IV. Overall, mean preoperative ABG was 31.5 ± 8.7 dB, which improved to 15.2 ± 7.3 dB postoperatively (p < 0.001). Significant postoperative improvement in PTA and ABG was observed across all ossiculoplasty types, with Type II showing superior closure compared to Type III and Type IV. Patients with cholesteatoma demonstrated slightly lesser postoperative hearing gain, consistent with prior studies showing differential outcomes in COM with and without cholesteatoma (1–3, 6, 14). Postoperative mean CSOM Outcome Score-15 indicated high subjective satisfaction, correlating with objective hearing improvements (p < 0.05). Complication rates were low, and none required major revision within the short-term follow-up. Conclusion: Ossiculoplasty across Types I–IV provides significant audiological improvement and high patient-reported satisfaction in CSOM patients, with Type II procedures showing favorable outcomes. The presence of cholesteatoma and ossicular staging remain important prognostic factors. This study supports ossiculoplasty as an effective intervention for reconstructing ossicular disruptions in chronic middle ear disease.