The Novel "Hot Dog" Technique for Reconstruction of Incudostapedial Discontinuity: A Randomized Controlled Trial.

Objectives: Chronic otitis media can cause ossicular chain discontinuity (OCD), especially erosion of long process of incus. This study introduces a novel "Hot Dog" technique for OCD reconstruction that combines glass ionomer cement (GIC) with autogenous cartilage dust and platelet-rich fibrin (PRF) to address these limitations. The aim is to evaluate the auditory and anatomical outcomes of the "Hot Dog" technique compared to GIC alone, and to describe the "Hot Dog" reconstruction method in detail.

Methods: This prospective, randomized controlled trial compared the "Hot Dog" technique to GIC alone for incudostapedial rebridging. Thirty-eight adult patients were included and randomized (18 patients in both study and control groups). Preoperative and postoperative pure-tone audiometry were performed. Air-bone gap (ABG) and ABG gain were measured at least 12 months postoperatively. Postoperative complications were assessed.

Results: Both groups achieved significant postoperative ABG closure (mean gain: 22.8 dB in "Hot Dog" vs 19 dB in GIC), with no statistically significant difference. A success rate of 100% (postoperative ABG ≤ 20 dB) was observed in both groups at a minimum 12-month follow-up. No complications were observed in the "Hot Dog" group, while 1 patient in the GIC group developed a postoperative tympanic membrane perforation.

Conclusion: The "Hot Dog" technique demonstrated promise for incudostapedial rebridging, achieving significant hearing improvement and a favorable complication profile compared to GIC alone. While a trend toward better hearing was observed, larger studies with longer follow-up are needed to confirm these findings and definitively compare its efficacy to established techniques.

Level of evidence: Level 1b.