Incus Replacement Malleostapedotomy in Quiescent Chronic Otitis Media With a Mobile Stapes Footplate: An Alternative to TORP in Select Cases

Objective: To review the results of malleostapedotomy for incus replacement in the setting of quiescent chronic otitis media and a mobile stapes footplate and to discuss the potential application for this technique in select cases. Patients: Seven individuals having undergone malleostapedotomy in the setting of quiescent chronic otitis media and a mobile stapes footplate between 2004 and 2009. Intervention: Review of surgical results and hearing outcomes as measured by preoperative and postoperative pure-tone audiometry. Main Outcome Measures: Closure of preoperative air-bone gap and change in preoperative versus postoperative pure-tone bone conduction thresholds. Results: Improvement in air-bone gap was noted in 6 of 7 subjects with an average closure of 17 dB. In 5 of 7 subjects, the air-bone gap was closed to 20 dB or less, and in 3 of 7 subjects, the air-bone gap was closed to 10 dB or less. No significant changes in postoperative bone conduction pure-tone average thresholds were noted. No immediate or delayed complications were encountered over an average follow-up time of 23.6 months ( range, 5-42 mo). Conclusion: Although the data are limited by the small sample size, malleostapedotomy seems to be a potentially safe and effective alternative to placement of a total ossicular replacement prosthesis in properly selected specialized instances of quiescent chronic otitis media. Further study is recommended to more definitively establish the safety and efficacy of this technique.