Middle ear ossiculoplasty – an experience of a single surgical unit

Background
Middle ear ossiculoplasty refers to the reconstruction of the middle ear ossicular chain when there is an in continuity or fixation of the ossicular chain due to disease process or trauma. Various materials and techniques have been used to regain the function and continuity of the ossicular chain. But the ideal reconstruction materials and techniques are yet to be developed.    The first ossiculoplasty was reported in modern medical literature by Matte in 1901. (1)  Since then, various people have used different materials and techniques for ossiculoplasty(2).

In a Sri Lankan setting, only a few centres of the country perform ossiculoplasty though almost all the Ear nose throat departments in the country perform myringoplasty for CSOM (Chronic suppurative otitis media). The main purpose of myringoplasty is to make the ear safe from  recurrent ear infection.  Improving hearing is not the main aim for myringoplasty in Sri Lanka though some patients get the hearing benefit.

Material and method
Gray’s total ossicular replacement prosthesis (TORP )and partial ossicular replacement prosthesis (PORP) were used. Retrospective data analysis was carried out from patients who underwent surgery from 1^st of July 2017 for three-year periods and calculated the success rate using the improvement of hearing in postoperative audiograms.

Conclusion and recommendations
Our experience in ossiculoplasty with TORP and PORP  showed a reasonable success rate on hearing for traumatic or infective conductive hearing loss. We recommend carrying out it routinely with myringoplasty in the case of damage ossicular chain in the middle ear. We also recommend the ministry of health to make available other types of ossicular prostheses like angular clip prosthesis and malleus replacement prosthesis in addition to TORP and PORP.