Endoscopic revision surgery for ossicular chain reconstruction: intraoperative findings and functional outcomes

To report the intraoperative observations and hearing outcomes in patients undergoing endoscopic revision ossiculoplasty.

A retrospective cohort of patients who had undergone revision ossiculoplasty were enrolled in this study. Intraoperative findings were documented. Follow-up visits were scheduled from 3 to 12 months post-surgery to assess hearing levels and record any potential complications.

Between April 2020 and May 2023, a total of 26 cases were enrolled, with 11 male patients represented. The mean age of the patients was 40.5 ± 9.4 years, ranging from 18 to 66 years. During the revision surgeries, various intraoperative findings were noted, including adhesive tissues affecting the activity of ossicular chain (observed in 37.0% of cases), tympanosclerosis of the ossicular chain (also in 37.0% of cases), dislocation of ossicular prosthesis (33.3%), erosion of the ossicular chain (33.3%), and identified cholesteatoma (11.1%). In terms of hearing outcomes, a significant improvement was observed. Overall, only 37.0% of patients achieved an air-bone gap of 20 dB or less, indicating the inferior outcome in revision ossiculoplasty.

This study highlight the role of inflammatory responses (adhesion, tympanosclerosis), stapes erosion, and prosthesis dislocation, as contributing factors to the failure of primary tympanoplasty. Endoscopic revision ossiculoplasty emerges as a reliable and effective approach.