Long-term results of ossiculoplasty: reasons for surgical failure.

Objectives: To present the value of a dedicated ear audit clinic, the overall long-term results of ossiculoplasty, and the reasons for surgical failure.

Study Design: Retrospective analysis was performed on ossiculoplasty cases in a county hospital. The information was extracted from a computer database. Individual patient case records were reviewed in all cases of surgical failure.

Methods: All patients who had ossiculoplasty were routinely followed-up in a dedicated ear audit clinic on a yearly basis. Between 1988 and 1999, the author performed 242 ossiculoplasties and their outcomes were monitored in the ear audit clinic. The 5-year results are presented.

Results: Even with the benefit of a dedicated audit clinic and a stable population, only 74.4% of ears had a known outcome at 5 years after ossiculoplasty. In the present series, 61.1% of partial and 37.6% of total ossicular reconstructions have an air-bone gap of 20 dB or better at 5 years. Of 83 identifiable late failures, 47 were caused by persistent or recurrent abnormalities within the middle ear and only 36 were thought to be caused by prosthesis-related or surgeon-related problems.

Conclusion: The overall long-term results of ossiculoplasty have not dramatically improved in recent years, in spite of all the great advances in biomedical technologies. Unless there is a breakthrough in the understanding and management of the underlying otitis media, the long-term outcome of ossiculoplasty is unlikely to improve dramatically.