Management of tympanosclerosis with ossicular fixation: review and presentation of long-term results of 30 new cases.

Objective: Surgery for tympanosclerosis has always been challenged with the risk of deterioration of hearing or the recurrence of the disease. If surgery is indicated, controversy exists regarding staging versus nonstaging and whether to perform stapedectomy or mobilize the fixed ossicles by removal of plaques. The aim of this study was to review the previous reports and to analyze the long-term surgical outcome of 30 patients who have been operated on owing to tympanosclerosis.

Methods: Nine hundred twelve cases with chronic otitis media with or without cholesteatoma that have undergone either the intact canal wall or canal wall down mastoidectomy technique were analyzed retrospectively. Thirty patients who underwent ossicular chain reconstruction between 1990 and 2005 owing to conductive hearing loss resulting from tympanosclerosis were selected after excluding those patients who had repair of a sclerotic eardrum only. The types of surgery for restoration of hearing loss, postoperative hearing gain, and closure of air-bone gaps were compared. The average follow-up was 4.3 years.

Results: There were 19 male and 11 female patients, with ages ranging between 12 and 48 (27.6 +/- 9 years). Fourteen patients (47%) underwent myringoplasty and ossiculoplasty only, 14 patients (47%) had simple mastoidectomy, and 2 patients (6%) had a modified radical mastoidectomy owing to associated cholesteatoma. Seven patients with advanced tympanosclerosis had stapedectomy and a total ossicular replacement prosthesis (TORP), five patients had stapes mobilization and a partial ossicular replacement prosthesis (PORP), two patients had incus transposition, one patient had a tragal cartilage graft over the stapes as ossicular reconstruction, and one patient had a graft over the incus. Fourteen patients with an intact ossicular chain had a mobilization procedure associated with mastoidectomy and atticotomy. Thirty-three percent of the patients had less than 20 dB air-bone gaps in the long term. Patients with stapedectomy with TORP and PORP application presented with better air-bone gap closure (to 20 dB) compared with those with the mobilization procedure only. None of the patients had a dead ear after surgery.

Conclusion: The success of the surgery was dictated by the location and the extent of tympanosclerotic involvement. Controversy still remains concerning the long-term results of the surgical management of tympanosclerosis, and the results are not satisfactory, as seen in surgery for otosclerosis.