Ossiculoplasty with Sculpted Incus; Hearing Results and Risk Factors

Background: Incus is the most common ossicle damage in ear trauma and chronic infection. Sculpted incus is one of the methods, which have been used for ossicular reconstruction, and transition of sound from tympanic membrane to stapes. Purpose: This paper reports the success rate and risk factors of ossiculoplasty with sculpted incus. Methods: A before-after clinical trial study on 25 patients with normal and mobile stapes who underwent ossiculoplasty using autologous or homologous sculpted incus was performed. Pre and post intervention audiometric results were compared. The utility of the middle ear risk index (MERI) in predicting hearing outcome in these cases were evaluated. Moreover, outcomes in patients with primary versus staged ossiculoplasty and incus interposition versus incus transposition were compared. P-value <0.05 was considered significant. Results: The mean preoperative air-bone gap (ABG) was 33.9 dB and mean postoperative ABG was 19.4 dB, with significant improvement (p-value = 0.001). The best results achieved in 2000 Hz with 13 dB improvement in mean ABG and worst results in 4000 Hz with 8.8dB improvement. Seventy-six percent of patients had postoperative mean ABG less than 20dB and 88% less than 25dB. Hearing results were not significantly different in primary ossiculoplasty when compared with staged procedure and in incus interposition ossiculoplasty compared with incus transposition. There was no correlation between preoperative and postoperative ABG or the middle ear risk index. Conclusion: Ossiculoplasty with sculpted incus has a good outcome and is recommended in the first stage tympanoplasty. This is independent of middle ear risk factors, if the stapes is normal and mobile.