The Journal of International
Advanced Otology
Original Article

The Effect of the Status of the Ossicular Chain and Choice of Graft Material on Hearing Outcomes in Pediatric Cholesteatoma Surgery


Department of Otolaryngology – Head and Neck Surgery, National Defence Medical College, Tokorozawa, Saitama, Japan


Department of Otolaryngology – Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada

J Int Adv Otol 2021; 17: 127-133
DOI: 10.5152/JIAO.2021.0090
Read: 482 Downloads: 146 Published: 14 April 2021

Objective: Compare hearing benefit of incus preservation in primary cholesteatoma surgery versus cartilage-myringostapediopexy.

Methods: Prospective cohort study in a tertiary referral center. Tympanoplasty utilizing cartilage or other grafts, with or without intact incus was performed in 195 ears (187 children) with intact stapes. Outcome measures were pre and post-operative four-tone air conduction (AC) threshold (0.5, 1, 2, 4 kHz) and proportion with normal hearing (AC ≤ 30 dB HL) at 12 months.

Results: Ears with intact ossicles had better post-operative AC thresholds than those with incus eroded or removed (median 20 dB HL vs. 30 dB HL, Mann–Whitney P < .001). The normal hearing rate was 81/106 (74%) with intact incus and 46/89 (52%) without (Fisher’s exact P = .001). Ears without intact incus and a cartilage-myringostapediopexy had better post-operative thresholds than those with a non-cartilage graft (28.8 dB HL vs. 36.3 dB HL, Mann–Whitney P = .005). Of ears without intact incus, 37/59 (63%) with a cartilage-myringostapediopexy and 9/30 (30%) with a non-cartilage graft had normal hearing post-operatively (Fisher’s exact P = .007). By preserving the incus in 12 ears, 1 more ear would have normal hearing than with incus removal plus cartilage-myringostapediopexy (NNT = 12 (CI 3.6-); Fisher’s exact = 0.1).

Conclusion: Preserving an intact ossicular chain conveys a small but significant hearing benefit in cholesteatoma surgery, the magnitude of which should be considered before deciding to remove the intact incus. Cartilage-myringostapediopexy provides a significant gain in hearing when the incus is absent, even without a partial ossicular replacement prosthesis.

Cite this article as: Kimura E, Leonard C, James A. The effect of the status of the ossicular chain and choice of graft material on hearing outcomes in pediatric cholesteatoma surgery. J Int Adv Otol. 2021; 17(2): 127-33.

EISSN 2148-3817