title: Results of primary ossiculoplasty in ears with an intact stapes superstructure and malleus handle: inflammation in the middle ear at the time of surgery does not affect hearing outcomes.
abstract: OBJECTIVE
  To determine whether any factors are predictive of success or failure in primary ossiculoplasty employing autologous bone in Austin-Kartush Group A (stapes and malleus handle present) ears.
  
  
  METHODS
  Retrospective review of a single-surgeon case series.
  
  
  METHODS
  Two District General Hospitals in the United Kingdom.
  
  
  METHODS
  Of 135 patients undergoing primary repair, 116 had sufficient data for analysis (mean follow-up 33 months).
  
  
  METHODS
  Postoperative air-bone gaps (pABG) in patients with differing qualities of middle-ear mucosa (active versus inactive), differing pathologies (mucosal versus squamous) and differing surgical procedures [canal-wall up (CWU) versus canal-wall down (CWD)].
  
  
  METHODS
  'Belfast Rule of Thumb' (operated ear hearing brought to 30 dB or better or to within 15 dB of contralateral ear).
  
  
  RESULTS
  Postoperative ABGs were closed within 10 dB in 37%, 20 dB in 74% at latest follow-up. The only significant factors predicting hearing outcomes were the status of the canal wall (CWU = 14.1 dB, CWD = 24.7 dB: significant, P = 0.00) and whether surgery was primary or revision. Mean ABG was 14.7 for inactive middle ear mucosa, 17.2 for active middle ear mucosa (not significant, P = 0.25). Excluding CWD procedures from the analysis improved outcomes to 80% (within 20 dB) and 41% (within 10 dB) overall, and the mean for active and inactive ears to 14.2 and 14.0 dB respectively. Postoperatively, 82% of patients fulfilled the 'Belfast Rule of Thumb'.
  
  
  CONCLUSIONS
  The most significant prognostic factor affecting hearing outcomes - status of the canal wall - is independent of staging. The factor most associated with staging - the status of the middle ear mucosa - is only weakly associated with a successful functional outcome.
authors.affiliation: Department of Otolaryngology, Walsall Manor Hospital, Walsall, UK. tpcmartin@blueyonder.co.uk
authors.forename: T P C
authors.initials: TP
authors.lastname: Martin
authors.forename: M D
authors.initials: MD
authors.lastname: Weller
authors.forename: D S
authors.initials: DS
authors.lastname: Kim
authors.forename: M C F
authors.initials: MC
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005260:Female; D006309:Hearing / Q000502:physiology*; D006801:Humans; D008297:Male; D008307:Malleus; D008875:Middle Aged; D008876:Middle Ear Ventilation; D009092:Mucous Membrane / Q000473:pathology; D019933:Ossicular Replacement / Q000379:methods*; D010033:Otitis Media / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D013199:Stapes; D055815:Young Adult