title: Tympanoplasty in chronic otitis media patients with an intact, but severely retracted malleus: a treatment challenge.
abstract: OBJECTIVE
  To analyze the outcome of patients with chronic otitis media (COM) with an intact, but markedly medialized ossicular chain, treated by removing the malleus head and interposing an autologous incus and then an underlay myringoplasty.
  
  
  METHODS
  Retrospective clinical study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  The search criteria within the prospective surgical database was COM with a central perforation (without cholesteatoma) with a markedly medialized malleus handle (the umbo adherent to the promontory) with an intact ossicular chain (study, n = 15) or an incus necrosis at the lenticular process (incus, n = 23). Only primary surgeries performed at our otorhinolaryngology department were included.
  
  
  METHODS
  All patients underwent the same surgical procedure consisting of an autologous incus interposition and underlay myringoplasty with temporalis fascia.
  
  
  METHODS
  The patients' audiological and follow-up data were retrieved from the database. The postoperative audiogram (0.5-3 kHz) with the longest follow-up was used.
  
  
  RESULTS
  The preoperative air-conduction thresholds were less impaired in the study group than in the incus group. After their surgery, all, except 3 patients, improved their hearing, and 97% had an intact tympanic membrane at a mean follow-up of 2 years. The air-bone gap was closed within 20 dB in 80% (study) and in 87% (incus), in one third of all patients even within 10 dB. Although the largest improvement was seen in the lower frequencies, closure of the air-bone gap at 4 kHz was difficult to achieve.
  
  
  CONCLUSIONS
  Patients presenting with COM, a (central) perforation, a medially rotated malleus and intact ossicular chain are a treatment challenge. Lateralizing the malleus handle may require disconnection of the ossicular chain and an autologous incus interposition to bring back the reconstructed tympanic membrane in its original position and improve the hearing.
authors: Department of Otorhinolaryngology, University Medical Centre, St Radboud, Nijmegen, The Netherlands. m.hol@kno.umcn.nl
authors: Myrthe K S
authors: MK
authors: Hol
authors: Dai Q
authors: DQ
authors: Nguyen
authors: Christoph
authors: C
authors: Schlegel-Wagner
authors: Gunther
authors: G
authors: Pabst
authors: Thomas E
authors: TE
authors: Linder
mesh_terms: D001298:Audiology; D001309:Auditory Threshold; D002908:Chronic Disease; D004429:Ear Ossicles / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007188:Incus / Q000473:pathology; D008307:Malleus / Q000473:pathology*; D009225:Myringoplasty; D009336:Necrosis; D010033:Otitis Media / Q000473:pathology* / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D014433:Tympanoplasty / Q000379:methods*