Ossiculoplasty

Indications

Reconstruction of the ossicular chain. The chain may be disrupted due to chronic otitis media (or its treatment), trauma, or congenital abnormality. 

Ossiculoplasty may be performed alone, or as part of the reconstruction after cholesteatoma excision.

The type of ossiculoplasty depends upon the amount of the ossicular chain remaining. Broadly, the prostheses are categorised into total and partial ossicular replacement prostheses (TORPs/PORPs).

Procedure

The middle ear is accessed by one of the above described methods. 

The prosthesis is attached to the remaining ossicular chain. If the prosthesis is approximated directly to the tympanic membrane, a piece of cartilage is used between the two to prevent extrusion. 

The tympanic membrane is reconstructed (if needed) and replaced.

Length of procedure

Variable; usually 1-2 hours.

Complications

Pain

Bleeding (rare)

Infection Rare.  If BIPP (a bright yellow antiseptic) ribbon is used, this causes a yellow-brown discharge which can be mistaken for infection.

Hearing loss  As with all middle ear procedures there is a small risk of hearing deterioration due to manipulation of the ossicular chain.

Prosthesis loosening This may occur over time in some cases, leading to deterioration in hearing.  Some patients may therefore require a revision procedure.

Facial palsy Very rare in ossiculoplasty alone.

Taste disturbance The chorda tympani runs across superior tympanic membrane, and should be identified and preserved.  Damage can lead to a metallic taste, although this usually improves over time.

Tinnitus 

Dizziness Usually a temporary postoperative effect, but occasionally persists.

Perforation of the tympanic membrane.

Reaction to BIPP packing A rare allergic-type reaction to BIPP packing (if used); the patient will have previously been sensitised by similar packing. The pinna and surrounding soft tissues will become hot and red quite soon ie within 24-36 hours of the operation, as distinct from a post-operative cellulitis.

Scar (if endaural/postauricular approach used).

Post-operative management

The patient can usually go home the same day. Followup is usually in 2 weeks for the removal of an ear canal dressing. Inform the surgeon if the patient experiences severe vertigo or sudden severe hearing loss.

TTO

Simple analgesia, and ear drops if the surgeon wishes.

 Page last reviewed: 4 January 2023