Comparison of hearing reconstruction techniques in tympanosclerosis with stapes fixation

Abstract

Background/Aim: Surgery for tympanosclerosis with stapes fixation for hearing reconstruction is controversial, with many reports in the relevant literature advocate opposing suggestions. The primary aims were to evaluate hearing improvement with varied hearing reconstruction techniques performed for tympanosclerosis with stapes fixation. Methods: Patients with tympanosclerosis and stapes fixation, whose hearing impairment was re-constructed surgically and who were followed for 1-5 years were reviewed in this retrospective cohort study. The audiological outcomes of reconstruction methods, including mobilization, partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP), and teflon pistons (TP) were documented. Results: The study included 76 ears of 76 patients; 29 ears in the mobilization technique group, 28 ears in the PORP technique group, 10 ears in the TORP technique group, and 9 ears in the TP technique group. When postoperative and preoperative hearing were evaluated, the mobilization and PORP techniques showed statistically significant improvement in both air conduction threshold gain and air-bone gap closure (P<0.05). Although some improvement was observed with the TORP and TP techniques, it was not significant (P>0.05). Bone conduction threshold showed no significant deterioration in any techniques. Conclusion: For hearing gain, mobilization and PORP were effective in tympanosclerosis patients with stapes fixation after removal of sclerotic plaques, whereas the TORP and TP techniques did not show significant improvement. It can be concluded that, if a functionally mobile stapes cannot be achieved, it is not advisable to perform TORP replacement or a stapedotomy. However, these methods may still be used in carefully selected patients and be successful in some.