Auditory Outcomes and Predictors Following Ossiculoplasty in Cholesteatoma Surgery: A Retrospective Analysis

Alexandre Karkas^1,2*Fabien Tinquaut³Asimakis Asimakopoulos^1,2Brandon Grondier¹Pierre Bertholon^1,2Ines Abounaidane¹

• ¹Department of Otolaryngology-Head & Neck Surgery. University Medical Center of Saint-Etienne, Saint-Etienne, France., SAINT-ETIENNE, France
• ²University Jean Monnet, School of Medicine, Saint-Etienne, France., SAINT-ETIENNE, France
• ³Department of Public Health Service, University Medical Center of Saint-Etienne, Saint-Etienne, France., SAINT-ETIENNE, France

Introduction: Middle ear cholesteatoma causes bone/ossicular erosion. The aim of our work was to analyze auditory results after ossiculoplasty in cholesteatoma surgery and search for predictors of hearing outcome related to middle ear or surgery. Methods: Retrospective study on patients undergoing ossiculoplasty in cholesteatoma surgery (2019-2024). Preoperative, short-term (2-month) and midterm (8-month) postoperative audiograms were obtained. Potential pre-/postoperative parameters influencing hearing were sought. Results: Eighty-eight cases were eligible (20 pediatric-68 adult). There were 56 primary surgeries and 28 preoperative cholesteatoma complications. In case of present stapes, a stapes-cartilage augmentation was mostly performed, followed by partial ossicular replacement prosthesis. In case of absent stapes, a total ossicular replacement prosthesis was used. There were 10 postoperative complications (1 prosthesis extrusion), and 16 residual cholesteatomas (1-3 years). Short-term mean postoperative gain in bone conduction (∆BC) was 0.3dB while midterm ∆BC was 1.4dB. Short-term mean postoperative gain in air conduction (∆AC) was 3.4dB while midterm ∆AC was 4.5dB. Short-term mean postoperative gain in ABG (∆ABG) was 3.4dB while midterm ∆ABG was 3.7dB. Preoperatively, younger age favorably influenced AC and BC and presence of stapes favorably influenced ABG. Postoperatively, regarding midterm ∆ABG, the absence of posterior tympanotomy was a predictor of good hearing outcome. Considering midterm postoperative ABG alone, the absence of mastoidectomy was a favorable predictive factor. Regarding midterm ∆AC, primary surgery was a predictor of good hearing outcome. Considering postoperative AC alone, there were 3 favorable predictive factors: younger age, primary surgery, and absence of mastoidectomy. There was no predictive factor for midterm ∆BC. The malleus handle had no effect on auditory results. Discussion: Postoperative auditory results of our study are fair, given the preoperative aggressiveness/extension of cholesteatoma, but were comparable to few other studies, as were the rates of postoperative complications and residual disease. Younger age and presence of stapes were predictive of better preoperative hearing. Postoperatively, younger age, absence of mastoidectomy, absence of posterior tympanotomy, and primary surgery were predictors of good hearing outcome. Results in the literature are highly variable, sometimes contradictory. This stems from the diversity of disease extension, surgical technique and materials used in ossiculoplasty.