Learning Objectives: To establish how ossicular preservation with the ‘gold standard’ for hearing treatment in cholesteatoma surgery. To compare the resilience of these techniques over a five year period.
Intro: This study compares the long term usefulness to patients of two different techniques of hearing reconstruction after cholesteatoma surgery: reconstruction using ossicular prosthesis on top of an intact, mobile stapes versus LASER facilitated ossicular chain preservation.
Method: At the end of surgery, ears with an intact ossicular chain were allocated to one group. Ears with a disrupted chain and an intact stapes superstructure onto which an ossiculoplasty had been performed were placed in the second group. All ears had primary cholesteatoma surgery using an intact canal wall technique with the use of a fibre-guided LASER.
Hearing after surgery was assessed with the Belfast rules of thumb. Audiograms were performed annually after surgery until the patient was discharged from regular follow-up or defaulted from follow-up.
The two sets of Belfast scores were assessed using survival analysis. The two groups were compared with the log-rank test.
Cox's model was used to investigate confounding influences.
Results: 80 ears with intact chains and 69 with an intact stapes and ossiculoplasty were included.
By five years, 76 per cent of patients with intact chains retained normal hearing.whilst 56 per cent in reconstructed ears.
Log-rank analysis gives χ2 = 10.6, n = 1, p = 0.001.
The intact ossicular chain (odds ratio: 2.78, CI 1.51–5.07, p = 0.001) and lower bone conduction hearing threshold (odds ratio: 1.1 per decibel, CI 1.07–1.13, p < 0.001) predicted the likelihood of maintaining socially useful hearing. A weaker effect of younger age (odds ratio 1.02, CI 1.00–1.04, p = 0.04) increasing the likelihood of loss of useful hearing was also detected.
Conclusions: Whenever the presentation permits, LASER facilitated preservation of the intact ossicular chain provides more durable useful hearing for our patients than ‘gold standard’ ossiculoplasty.
There is a gradual deterioration in outcomes in both groups which is more marked in the ossiculoplasty group.
