Ryan T Judd, Michael B Gluth, Richard K Gurgel, John L Dornhoffer, Matthew L Carlson, Brandon Isaacson, Jafri Kuthubutheen, Ng Jia Hui, Mark Quick, Ryan D Anderson, Mark Sakai, Jason H Barnes, Wanda L Fussell
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After controlling for EER score, malleus engagement of prosthesis yielded favorable ABG versus direct contact to tympanic membrane without malleus engagement (beta = -2.4 dB [-3.8, -1.1], p < 0.001). For total ossicular replacement prostheses (TORP), use of a footplate prosthesis yielded favorable ABG as compared with no footplate prosthesis (-3.6 dB [-6.1, -1.1], p = 0.005). For synthetic prostheses, polyethylene prostheses had a less favorable ABG compared with full titanium or titanium with hydroxyapatite prostheses (p < 0.05). In cases where the malleus was not engaged in reconstruction, amputation of the malleus head yielded worse ABG (+3.9 dB [1.2, 6.7], p = 0.005). There was no significant difference (p > 0.05) in ABG for single-stage versus multistaged approach, use of a cartilage cap over the prosthesis versus no cartilage, use of bone cement to secure a PORP to the stapes versus no cement, mastoid cavity obliteration versus no obliteration, and incudostapedial joint reconstruction with joint prosthesis/bone cement versus synthetic PORP.</p><p><strong>Conclusions: </strong>With statistical correction for ear environment risk, several modifiable surgical factors are noted to impact ossiculoplasty hearing outcomes.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Modifiable Surgical Factors on Ossiculoplasty Outcomes After Controlling for Ear Environment Risk: A Multi-Institutional Study.\",\"authors\":\"Ryan T Judd, Michael B Gluth, Richard K Gurgel, John L Dornhoffer, Matthew L Carlson, Brandon Isaacson, Jafri Kuthubutheen, Ng Jia Hui, Mark Quick, Ryan D Anderson, Mark Sakai, Jason H Barnes, Wanda L Fussell\",\"doi\":\"10.1097/MAO.0000000000004611\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the impact of modifiable surgical factors on ossiculoplasty outcomes after controlling for ear environment risk.</p><p><strong>Study design: </strong>Multi-institutional retrospective review.</p><p><strong>Setting: </strong>Six tertiary care centers from 2011 to 2019.</p><p><strong>Patients: </strong>Adults and children.</p><p><strong>Interventions: </strong>Ossiculoplasty, including synthetic ossicular replacement prosthesis, autograft interposition, bone cement repair, and mobilization.</p><p><strong>Main outcome measure: </strong>Correlation between modifiable surgical factors and pure-tone average air-bone gap (ABG) at most recent audiogram after controlling for preoperative risk using the statistically validated Ear Environment Risk (EER) score.</p><p><strong>Results: </strong>A total of 1,679 cases were included with a median follow-up time of 20 months (IQR, 5-51). After controlling for EER score, malleus engagement of prosthesis yielded favorable ABG versus direct contact to tympanic membrane without malleus engagement (beta = -2.4 dB [-3.8, -1.1], p < 0.001). For total ossicular replacement prostheses (TORP), use of a footplate prosthesis yielded favorable ABG as compared with no footplate prosthesis (-3.6 dB [-6.1, -1.1], p = 0.005). For synthetic prostheses, polyethylene prostheses had a less favorable ABG compared with full titanium or titanium with hydroxyapatite prostheses (p < 0.05). In cases where the malleus was not engaged in reconstruction, amputation of the malleus head yielded worse ABG (+3.9 dB [1.2, 6.7], p = 0.005). 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引用次数: 0
摘要
目的：探讨控制耳部环境风险后可改变的手术因素对听骨成形术效果的影响。研究设计：多机构回顾性评价。环境：2011年至2019年，六个三级护理中心。患者：成人和儿童。干预措施：听骨成形术，包括人工合成听骨置换假体、自体移植物插入、骨水泥修复和活动。主要结果测量：在使用经统计验证的耳环境风险（EER）评分控制术前风险后，可修改的手术因素与最近听音纯音平均气骨间隙（ABG）之间的相关性。结果：共纳入1679例，中位随访时间为20个月（IQR, 5-51）。在控制EER评分后，假体与鼓槌接触相比，直接接触鼓膜的ABG更好（β = -2.4 dB [-3.8, -1.1], p < 0.001）。对于全听骨置换术（TORP），与不使用足板假体相比，使用足板假体可获得良好的ABG （-3.6 dB [-6.1, -1.1], p = 0.005）。对于人工假体，聚乙烯假体的ABG较全钛或钛与羟基磷灰石假体差（p < 0.05）。在不进行外踝重建的病例中，切除外踝头的ABG更差（+3.9 dB [1.2, 6.7], p = 0.005）。单阶段与多阶段入路的ABG、假体上使用软骨帽与不使用软骨、骨水泥将PORP固定在镫骨上与不使用骨水泥、乳突腔封堵与不封堵、假体/骨水泥与合成PORP重建的包括镫骨关节无显著差异（p > 0.05）。结论：通过对耳环境风险的统计校正，注意到几个可改变的手术因素会影响听骨成形术的听力结果。证据等级：4。
Impact of Modifiable Surgical Factors on Ossiculoplasty Outcomes After Controlling for Ear Environment Risk: A Multi-Institutional Study.
Objective: To determine the impact of modifiable surgical factors on ossiculoplasty outcomes after controlling for ear environment risk.
Study design: Multi-institutional retrospective review.
Setting: Six tertiary care centers from 2011 to 2019.
Patients: Adults and children.
Interventions: Ossiculoplasty, including synthetic ossicular replacement prosthesis, autograft interposition, bone cement repair, and mobilization.
Main outcome measure: Correlation between modifiable surgical factors and pure-tone average air-bone gap (ABG) at most recent audiogram after controlling for preoperative risk using the statistically validated Ear Environment Risk (EER) score.
Results: A total of 1,679 cases were included with a median follow-up time of 20 months (IQR, 5-51). After controlling for EER score, malleus engagement of prosthesis yielded favorable ABG versus direct contact to tympanic membrane without malleus engagement (beta = -2.4 dB [-3.8, -1.1], p < 0.001). For total ossicular replacement prostheses (TORP), use of a footplate prosthesis yielded favorable ABG as compared with no footplate prosthesis (-3.6 dB [-6.1, -1.1], p = 0.005). For synthetic prostheses, polyethylene prostheses had a less favorable ABG compared with full titanium or titanium with hydroxyapatite prostheses (p < 0.05). In cases where the malleus was not engaged in reconstruction, amputation of the malleus head yielded worse ABG (+3.9 dB [1.2, 6.7], p = 0.005). There was no significant difference (p > 0.05) in ABG for single-stage versus multistaged approach, use of a cartilage cap over the prosthesis versus no cartilage, use of bone cement to secure a PORP to the stapes versus no cement, mastoid cavity obliteration versus no obliteration, and incudostapedial joint reconstruction with joint prosthesis/bone cement versus synthetic PORP.
Conclusions: With statistical correction for ear environment risk, several modifiable surgical factors are noted to impact ossiculoplasty hearing outcomes.
期刊介绍：
Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and cranial base surgery. As the foremost journal in its field, it has become the favored place for publishing the best of new science relating to the human ear and its diseases. The broadly international character of its contributing authors, editorial board, and readership provides the Journal its decidedly global perspective.
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