title: Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index.
abstract: OBJECTIVE
  The aims of this study were to investigate the prognostic impact of middle ear risk index on the postoperative hearing results in cases with type 2 ossiculoplasty; to compare the middle ear risk index results among primary, staged, and revision cases; and to compare the results of the prostheses used in ossicular reconstruction.
  
  
  METHODS
  Records of 293 patients who had canal wall up tympanomasteidectomy and type 2 ossiculoplasty due to chronic otitis media between November 1995 and November 2007 were reviewed retrospectively.
  
  
  RESULTS
  The mean preoperative air-bone gap was 32.6 dB, and it decreased to 15.2 dB after a mean follow-up period of 26.8 months postoperatively. The mean change of air-bone gap was 17.4 dB. Postoperative air-bone gap was 20 dB or less in 79% of the cases. The patients with dry perforations were in the low-risk group, and 91% of them had an air-bone gap of 20 dB or less. This value was 86% in the ones with intact malleus. The patients who had primary surgery were found in moderate risk group, whereas staged and revision groups were in the high-risk group. The air-bone gap was 20 dB or less in 84%, 78%, and 59%, respectively, of those groups. The difference between the primary and the revision groups reached a statistical significance.
  
  
  CONCLUSIONS
  We had the best ossicular reconstruction results with glass ionomer cement, whereas the worst results were obtained with allograft partial ossicular replacement prostheses. We determined that risk-reducing factors such as dry ear, minimal ossicular chain defect, and intact malleus were important to have successful results. The middle ear risk index is a valuable tool for the surgeon to judge the risks and the probability success of the procedure as well as to make a good patient selection.
authors.affiliation: Ministry of Health Ankara Training and Research Hospital, 2nd E.N.T. Department, Ankara, Turkey. saslanfelek@yahoo.com
authors.forename: Sevim Aslan
authors.initials: SA
authors.lastname: Felek
authors.forename: Hatice
authors.initials: H
authors.lastname: Celik
authors.forename: Ahmet
authors.initials: A
authors.lastname: Islam
authors.forename: Atilla H
authors.initials: AH
authors.lastname: Elhan
authors.forename: Munir
authors.initials: M
authors.lastname: Demirci
authors.forename: Erdal
authors.initials: E
authors.lastname: Samim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry; D001844:Bone Conduction; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement; D010033:Otitis Media / Q000601:surgery; D013506:Otologic Surgical Procedures; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012598:Sclerosis; D014432:Tympanic Membrane / Q000473:pathology / Q000601:surgery; D055815:Young Adult