Class III Congenital Middle Ear Anomalies: Refining the Teunissen-Cremers Classification Based on Stapes Suprastructure Viability.

Objective: This study aims to evaluate the surgical outcomes of partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP) in class III congenital middle ear anomalies (CMEAs) based on stapes suprastructure integrity and to propose a refined Teunissen-Cremers classification.

Study design: A retrospective cohort study.

Setting: A tertiary academic medical center.

Methods: Forty-nine ears from 46 patients with class III CMEAs who underwent ossiculoplasty from 2012 to 2024 were included. Patients were categorized into the viable suprastructure group (26 ears), with intact or mildly dysplastic suprastructures requiring PORP, and the non-viable suprastructure group (23 ears), with severely dysplastic or absent suprastructures requiring TORP. Exclusion criteria included revision surgeries, other types of CMEAs, and a follow-up period of <6 months.

Results: Preoperative demographics and hearing thresholds were comparable between groups. Postoperative air-bone gap (ABG) closure within 10 dB was significantly more frequent in the viable group (80.8%) compared to that in the non-viable group (52.2%, P = .033). ABG closure within 20 dB was achieved in 100% of the viable group and 91.3% of the non-viable group (P = .215). Postoperative complications, including sensorineural hearing loss and prosthesis extrusion, were similar between groups (P > .05).

Conclusions: Ossiculoplasty with PORP in viable cases demonstrated better ABG closure compared to TORP in non-viable cases. Further investigation is warranted to determine the influence of baseline hearing differences on these outcomes. A refined Teunissen-Cremers classification, subdividing class IIIa into IIIa1 (viable) and IIIa2 (non-viable) based on stapes suprastructure integrity, may improve prosthesis selection and prognostic assessment.