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Objective: To assess the efficacy of partial ossicular chain reconstruction using autologous cartilage., Design: Prospective study (April 1, 1997, through January 1, 2008)., Setting: Tertiary academic children's hospital., Patients: Two hundred forty-eight children (268 ears) underwent partial ossicular chain reconstruction using a shaped block of tragal cartilage interposed between the head of the stapes and an underlay tympanic membrane reconstruction along with tragal cartilage and its perichondrium., Main Outcome Measures: Anatomical and audiologic results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery guidelines. χ² Tests and multivariate analysis were used for statistical evaluation., Results: Mean age at surgery was 10.9 years. Single-stage surgery was performed in 124 ears (46.3%) (62.9% for cholesteatomas and 32.3% for retraction pockets). Second-look patients (53.7%) included 93.8% of staged surgery. Audiometric results were available for 222 ears at 1 year and for 78 ears at 5 years. Closure of the average air-bone gap (ABG) to within 20 dB was achieved in 62.2% of ears at 1 year. The mean (SD) preoperative and 1-year postoperative ABGs were 25 (11.8) dB and 18.9 (10.3) dB, respectively. Anatomical results were satisfactory in 87.3%. No cases of extrusion, resorption, or displacement of the cartilage were encountered. No statistically significant difference was found between audiometric results at 1 and 5 years. Multivariate analysis showed a significant negative correlation between preoperative and postoperative ABGs and between postoperative otitis media with effusion and postoperative ABG (P < .05)., Conclusions: Cartilage ossiculoplasty is a reliable technique for partial ossicular replacement. Long-term hearing outcomes remain stable and satisfactory. Preoperative ABG and postoperative otitis media are the predictive factors of the hearing outcome.

The authors analysed 62 cases of severe iatrogenic complications occurring after middle ear surgery (death, cophosis, PFP) between 1976 and 1986. They compared their results to those of a similar study conducted between 1950 and 1975. They observed an increase in the number of legal proceedings, probably due more to the increased demand by patients than to a higher incidence of these complications. Civil proceedings are much more frequent than penal proceedings. The authors stress the importance attributed by judges to the expert report and to the obtaining of informed consent.