title: Is it the middle ear disease or the reconstruction material that determines the functional outcome in ossicular chain reconstruction?
abstract: OBJECTIVE
  To evaluate the effects and the predictive value of environmental risk factors on the success of different reconstruction materials used in ossiculoplasty.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral university hospital.
  
  
  METHODS
  Between January 2007 and October 2010, 110 patients who underwent ossiculoplasty with or without mastoidectomy due to chronic otitis media were enrolled in the study. All patients were classified into 1 of the 3 risk groups (mild, moderate, and severe) according to their measured Middle Ear Risk Index score.
  
  
  METHODS
  The patients underwent exploratory tympanotomy, tympanoplasty, or tympanomastoidectomy (canal wall-up or wall-down), all with ossicular reconstruction. The ossicular reconstructions were performed using either bone cement, autologous bone interposition, or allograft material.
  
  
  METHODS
  For each patient, the air-conduction threshold and air-bone gap (ABG) were measured at the 12th month after ossiculoplasty. The ABG gain and air-conduction improvement were compared with preoperative values. The correlation of the success of ossiculoplasty with the middle ear risk group of patients was investigated. Moreover, the efficacy of different types of reconstruction material on the success of ossiculoplasty in the same risk group was evaluated.
  
  
  RESULTS
  In the mild- and moderate-risk groups, the ABG gain (p = 0.001 and p = 0.014) and air-conduction improvement (p < 0.001 for both) were statistically significant, whereas those changes were found to be insignificant in the severe-risk group. Moreover, the ABG gain and air-conduction improvement in none of the risk groups revealed a significance in favor of any of the used reconstruction materials.
  
  
  CONCLUSIONS
  The results of this study revealed that none of the reconstruction materials or specific techniques have a superiority in the functional outcomes in patients from the same middle ear risk group. We conclude that the success of ossiculoplasty is highly correlated with the pathophysiological status of the middle ear and is independent of the type of replacement material.
authors.affiliation: Department of Otolaryngology, Uludag University Medical School, Bursa, Turkey. uygardemir@hotmail.com
authors.forename: Uygar Levent
authors.initials: UL
authors.lastname: Demir
authors.forename: Sait
authors.initials: S
authors.lastname: Karaca
authors.forename: Omer Afsin
authors.initials: OA
authors.lastname: Ozmen
authors.forename: Fikret
authors.initials: F
authors.lastname: Kasapoglu
authors.forename: Hamdi Hakan
authors.initials: HH
authors.lastname: Coskun
authors.forename: Oguz
authors.initials: O
authors.lastname: Basut
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004427:Ear Diseases / Q000601:surgery*; D004429:Ear Ossicles / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019933:Ossicular Replacement / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*; D055815:Young Adult