Exclusive endoscopic management of incus long process major defects: conventional incus interposition versus malleostapediopexy

The aim of the current study is to compare the surgical and audiometric results of conventional incus interposition (IP) versus malleostapediopexy (MS) in incus long process large defects.

A total of 71 patients (incus IP group n = 37, MS group n = 34) were enrolled in this study. All patients enrolled in the current study underwent ossiculoplasty via an exclusive endoscopic transcanal approach. Pre- and postoperative audiometric measurements and air–bone gap (ABG) values were compared, and if the postoperative ABG value was less than 20 dB, ossiculoplasty was considered successful. Graft success rates and complications were also compared.

The average auditory gain was 14.7 ± 4.2 dB in the incus IP group and 18.3 ± 5.1 dB in the MS group. The auditory gain was significantly greater in the MS group relative to the incus IP group (p = 0.012). Ossiculoplasty success (postoperative ABG value < 20 dB) rate was 70.3% in the incus IP group patients and 88.2% in the MS group patients (p < 0.001). There was no significant difference in terms of graft success rate between groups (p > 0.05) and the overall graft uptake rate was 91.5% (65/71).

Malleostapediopexy—bridging of malleus and stapes using bone cement—is an effective, reasonable, and more efficient technique in terms of auditory outcomes relative to the conventional incus interposition in endoscopic transcanal management of incus long process major defects.