Erosion of the long process of the incus with incomplete ossicular discontinuity in simple chronic otitis media: Should we reconstruct or leave it be?

OBJECTIVE

To determine whether patients with simple chronic otitis media and incomplete ossicular discontinuity should undergo ossicular reconstruction.

DESIGN

Prospective, randomised surgical trial comparing no intervention with incus interposition over a 5-year period.

SETTING

Tertiary referral hospital.

PARTICIPANTS

Seventy-six participants with simple chronic otitis media and erosion of the long process of the incus but apparent good transmission throughout the ossicular chain as tested intra-operatively. Forty-four patients had partial erosion of the incus but still bony contact with the stapes head (Group A-Type I), and 32 had mainly connective tissue binding the incus and stapes (Group B-Type II). Each of these groups was randomised to either leaving the ossicular chain as it was (A1 and B1) or performing an incus interposition (A2 and B2).

MAIN OUTCOME MEASURES

Average postoperative air-bone gap and the degree of ABG closure. A postoperative air-bone gap under 20 dB was considered a successful result.

RESULTS

In group A, there was no significant difference between no intervention and incus interposition. In group B, patients in the no reconstruction subgroup had a significantly worse hearing result than the incus interposition subgroup (postoperative air-bone gap of 27.5 dB and 31% closure within 20 dB vs 15 dB and 75% closure).

CONCLUSIONS

For Type I patients, the postoperative hearing results were similar for the reconstruction and no reconstruction groups. For Type II patients, the results clearly favour reconstruction.