Hearing outcomes in ossiculoplasty: comparison between materials using the Ear Environment Risk Score
DOI:
https://doi.org/10.34631/sporl.3168Keywords:
Ossiculoplasty, Chronic otitis mediaAbstract
Introduction: Chronic otitis media frequently involves destruction of the ossicular chain, resulting in disruption of sound conduction between the tympanic membrane and the oval window. Ossiculoplasty aims to restore sound transmission between these two structures.
The assessment of hearing outcomes after oscilloplasty is challenging due to the heterogeneity of the middle ear environment. The Ear Environment Risk (EER) score was developed to stratify this risk and allow a more objective comparison of surgical outcomes.
Objectives: The aim of this study was to evaluate the impact of reconstruction materials (autologous vs titanium) on functional success using an EER- adjusted approach.
Methods: A retrospective cohort study was conducted including patients who underwent oscilloplasty between 2014 and 2024.
The primary outcome was late functional success (≥6 months after surgery) based on the EER index. Comparisons between reconstruction materials were performed using the chi-square (χ2)(χ2) test or Fisher's exact test, as appropriate. Multivariable logistic regression was performed to assess the independent association between reconstruction material and outcome, adjusting for oscilloplasty type (PORP vs TORP) and canal wall down mastoidectomy. A secondary sensitivity model additionally adjusted for the presence of cholesteatoma.
Secondary analyses evaluated early (<6 months) versus late (≥6 months) outcomes and the stability of results over time using transition analysis.
Results: A total of 120 ears were included, of which 102 (85.0%) had a late postoperative audiogram (≥6 months).
EER-based functional success was achieved in 65.8% of cases, with no significant difference between autologous reconstruction (61.7%) and titanium reconstruction (70.0%; p=0.413p=0.413 ). These findings were consistent across subgroup analyses.
In the multivariable analysis, reconstruction material was not independently associated with EER- based functional success (adjusted OR 1.44; 95% CI 0.54-3.81). These results remained unchanged after adjustment for ossiculoplasty type (PORP or TORP) and the presence of a radical mastoidectomy cavity. Additional adjustment for the presence of cholesteatoma did not materially alter the findings.
EER-based early success rates (at T1) also did not differ significantly between materials. Transition analysis in the 95 ears with complete follow-up showed that 61.5%61.5% maintained functional success from the early to the late postoperative period. The overall distribution of functional outcome transitions did not differ significantly between materials (p=0.234)(p=0.234) .
Conclusions: Evaluation of ossiculoplasty using an EER-based risk-adjusted model demonstrated comparable hearing outcomes between autologous materials and titanium.
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