Comparison of the Hearing Results of Total Ossicular Chain Autogenous Mastoid Cortical Bone Ossiculoplasty and Titanium Total Ossicular Replacement Prosthesis in Patients with Cholesteatoma


Hearing outcomes
Mastoid bone
Ossicular replacement prostheses

How to Cite

Karakus, M. F., Ozcan, K. M., Karakurt, S. E., Colak, M., Eravci, F. C., Yagmur, A. R., Cetin, M. A., & Dere, H. H. . (2021). Comparison of the Hearing Results of Total Ossicular Chain Autogenous Mastoid Cortical Bone Ossiculoplasty and Titanium Total Ossicular Replacement Prosthesis in Patients with Cholesteatoma. Iranian Red Crescent Medical Journal, 23(1).


Background: No studies have investigated the results of ossicular chain reconstruction using mastoid cortical bone ossiculoplasty (MCBO) and titanium total ossicular replacement prosthesis (TiTORP) in Austin-Kartush Group D cholesteatoma patients with severe middle ear risk index (MERI).

Objectives: The present study aimed to compare the hearing results of MCBO and TiTORP in Austin-Kartush Group D cholesteatoma patients with severe MERI who underwent ossicular chain reconstruction during primary surgery.

Methods: The hearing results of 28 adult cholesteatoma patients who underwent tympanomastoidectomy and ossicular chain reconstruction with MCBO (n=15) or TiTORP (n=13) were analyzed in the current study. The postoperative hearing was tested 12 months after the surgery.  The hearing-related functional success rate was determined in accordance with the American Academy of Otolaryngology-Head and Neck Surgery Foundation criteria.

Results: When all patients were taken into account, the mean preoperative and postoperative air-bone gaps (ABG) were reported as 32.2 decibel (dB) and 17.6 dB, respectively, (P<0.001). In 57.1% of the patients, the mean postoperative ABG was ≤ 20 dB. The mean preoperative and postoperative ABGs of the MCBO group were obtained at 29.9 and 16.2 dB, while these values were reported as  35.0 and 19.3 dB in the TiTORP group (P=0.001 and P<0.001, respectively). Hearing-related functional success rates were calculated at 60.0% and 53.8% in MCBO and TiTORP groups, respectively, without any significant difference between the groups (P= 0.743).

Conclusion: As evidenced by the obtained results, MCBO and TiTORP can provide similar and successful hearing results in Austin-Kartush Group D patients with cholesteatoma; nonetheless, MCBO is a more cost-effective option in this regard.


  1. Ocak E, Beton S, Meço C, Dursun G. Titanium versus hydroxyapatite prostheses: comparison of hearing and anatomical outcomes after ossicular chain reconstruction. Turk Arch Otorhinolaryngol. 2015;53(1):15-8. doi: 10.5152/tao.2015.775. [PubMed: 29391971].
  2. Austin DF. Ossicular reconstruction. Otolaryngol Clin North Am. 1972;5(1):145-60. [PubMed: 4551408].
  3. Kartush JM. Ossicular chain reconstruction. Capitulum to malleus. Otolaryngol Clin North Am. 1994;27(4):689-715. [PubMed: 7984370].
  4. Şevik Eliçora S, Erdem D, Dinç AE, Damar M, Bişkin S. The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery. Eur Arch Otorhinolaryngol. 2017;274(2):773-80. doi: 10.1007/s00405-016-4350-5. [PubMed: 27837423].
  5. Wullstein H. Theory and practice of tympanoplasty. Laryngoscope. 1956;66(8):1076-93. doi: 10.1288/00005537-195608000-00008. [PubMed: 13358259].
  6. Becvarovski Z, Kartush JM. Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI). Laryngoscope. 2001;111(10):1806-11. doi: 10.1097/00005537-200110000-00026. [PubMed: 11801949].
  7. Monsell EM. New and revised reporting guidelines from the Committee on Hearing and Equilibrium. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg. 1995;113(3):176-8. doi: 10.1016/S0194-5998(95)70100-1. [PubMed: 7675474].
  8. Demir UL, Karaca S, Özmen ÖA, Kasapoğlu F, Coşkun HH, Basut O. Is it the middle ear disease or the reconstruction material that determines the functional outcome in ossicular chain reconstruction? Otol Neurotol. 2012;33(4):580-5. doi: 10.1097/MAO.0b013e31824b774c. [PubMed: 22429941].
  9. Torun MT, Yalçın Y, Ender Seçkin E. The effect of the reconstruction materials to the hearing levels in ossiculoplasty: long term results. KBB Forum Electron J Otolaryngol Head Neck Surg. 2017;16(1):14-9.
  10. Yu Z, Zhang L, Han D. Long-term outcome of ossiculoplasty using autogenous mastoid cortical bone.J Laryngol Otol. 2014;128(10):866-70. doi: 10.1017/S0022215114002023. [PubMed: 25248969].
  11. Mudhol RS, Naragund AI, Shruthi VS. Ossiculoplasty: revisited. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 3):451-4. doi: 10.1007/s12070-011-0472-7. [PubMed: 24427696].
  12. Attanasio G, Gaudio E, Mammola CL, Cagnoni L, De Seta D, Minni A, et al. Autograft ossiculoplasty in cholesteatoma surgery: a histological study. Acta Otolaryngol. 2014;134(10):1029-33. doi: 10.3109/00016489.2014.907502. [PubMed: 25220725].
  13. Redaelli de Zinis LO. Titanium vs hydroxyapatite ossiculoplasty in canal wall down mastoidectomy. Arch Otolaryngol Head Neck Surg. 2008;134(12):1283-7. doi: 10.1001/archotol.134.12.1283. [PubMed: 19075123].
  14. Lee JI, Yoo SH, Lee CW, Song CI, Yoo MH, Park HJ. Short-term hearing results using ossicular replacement prostheses of hydroxyapatite versus titanium. Eur Arch Otorhinolaryngol. 2015;272(10):2731-5. doi: 10.1007/s00405-014-3274-1. [PubMed: 25193550].
  15. Dornhoffer JL, Gardner E. Prognostic factors in ossiculoplasty: a statistical staging system. Otol Neurotol. 2001;22(3):299-304. doi: 10.1097/00129492-200105000-00005. [PubMed: 11347630].
  16. Stankovic MD. Audiologic results of surgery for cholesteatoma: short- and long-term follow-up of influential factors. Otol Neurotol. 2008;29(7):933-40. doi: 10.1097/MAO.0b013e31818201af. [PubMed: 18667943].
  17. Blom EF, Gunning MN, Kleinrensink NJ, Lokin AS, Bruijnzeel H, Smit AL, et al. Influence of ossicular chain damage on hearing after chronic otitis media and cholesteatoma surgery: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2015;141(11):974-82. doi: 10.1001/jamaoto.2015.2269. [PubMed: 26502037].
  18. Ho SY, Battista RA, Wiet RJ. Early results with titanium ossicular implants. Otol Neurotol. 2003;24(2):149-52. doi: 10.1097/00129492-200303000-00005. [PubMed: 12621325].
  19. Stupp CH, Dalchow C, Grun D, Stupp HF, Wustrow J. Three years of experience with titanium implants in the middle ear. Laryngorhinootologie. 1999;78(6):299-303. doi: 10.1055/s-2007-996875. [PubMed: 10439346].
  20. Gelfand YM, Chang CY. Ossicular chain reconstruction using titanium versus hydroxyapatite implants. Otolaryngol Head Neck Surg. 2011;144(6):954-8. doi: 10.1177/0194599811399738. [PubMed: 21493321].
  21. Felek SA, Celik H, Islam A, Elhan AH, Demirci M, Samim E. Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index. Am J Otolaryngol. 2010;31(5):325-31. doi: 10.1016/j.amjoto.2009.03.006. [PubMed: 20015772].
  22. O’Reilly RC, Cass SP, Hirsch BE, Kamerer DB, Bernat RA, Poznanovic SP. Ossiculoplasty using incus interposition: hearing results and analysis of the Middle Ear Risk Index. Otol Neurotol. 2005;26(5):853-8. doi: 10.1097/01.mao.0000185054.92265.b7. [PubMed: 16151328].
  23. Zakzouk A, Bonmardion N, Bouchetemble P, Lerosey Y, Marie JP. Titanium prosthesis or autologous incus for total ossicular reconstruction in the absence of the stapes suprastructure and presence of mobile footplate. Eur Arch Otorhinolaryngol. 2015;272(10):2653-7. doi: 10.1007/s00405-014-3212-2. [PubMed: 25086865].
  24. Gardner EK, Jackson CG, Kaylie DM. Results with titanium ossicular reconstruction prostheses. Laryngoscope. 2004;114(1):65-70. doi: 10.1097/00005537-200401000-00011. [PubMed: 14709997].
  25. Malhotra M, Varshney S, Malhotra R. Autologous total ossicular replacement prosthesis. J Laryngol Otol. 2014;128(12):1050-5. doi: 10.1017/S0022215114002679. [PubMed: 25384928].