Ossicular Chain Reconstruction in a Developing Country

Abstract

Objectives: In Ethiopia, 2-stage operations with middle ear prostheses are economically unfavorable. We hypothesized that single-stage autologous ossiculoplasty results in acceptable tympanic membrane (TM) and hearing improvements in a setting of limited resources. Methods: One hundred eighty-eight patients (197 ears) who underwent 1-stage autologous ossiculoplasty for ossicular dysfunction are presented. All but 14 of these ears also had perforations of the TM. Conditions of the middle ear were granulation tissue, ossicular disruption only, tympanosclerosis, and cholesteatoma. Reconstructions of the ossicular chain were performed with autologous ossicles only. Results: The closure rate of TM perforations was 95%. Preoperative air bone gaps were 27 to 60 dB (mean [SD] = 44 [7] dB); postoperative air bone gaps were 0 to 50 dB (average [SD] = 23 [10] dB), for an average improvement of 21 dB across all reconstruction types ( P < .001). The largest favorable changes in air bone gaps were with incus and malleus columellas from the footplate to the TM (33 and 23 dB, respectively) ( P < .001). No patient had worsening of sensorineural hearing levels or extrusion of the reconstructed ossicles. Conclusion: Autologous ossiculoplasty performed well in this setting. Acceptable TM closure rates and improvement of air bone gaps were seen in 1-stage operations without the use of prostheses.