Tympanoplasty after ear trauma: review of pathology, management and outcomes.

Objective: The aim of the retrospective study was to compare the reconstruction results of total (TORP) or partial (PORP) ossicular replacement prostheses after ear trauma. Methods: Fifteen patients with conductive or mixed hearing loss due to trauma were retrospectively analyzed. Patients underwent tympanoplasty in tertiary referral center between 2009 to 2018 using TORP (n=10 patients) or PORP (n=5). Their mean age was 36 years. 80% of the study group was men. Demographic data, clinical data, audiometric data and intraoperative findings were collected. Air and bone conduction hearing thresholds were measured by pure tone audiometry on initial admission, at 1 and at least 2 years postoperatively. The hearing threshold was calculated as the mean value of the threshold for 500, 1000, 2000, and 4000 Hz. Results: The most common cause of ear injury was head trauma, then foreign body, burn and explosion. Incudostapedial disarticulation or damage of incus was the most common ossicular pathology. In the TORP group the air conduction pure tone average was 53.75±19.26 dB HL preoperatively, 42.38±21.04 dB HL 1 year postoperatively and 42.75±21.51 dB HL at least 2 years postoperatively. In the PORP group the air conduction pure tone average was 50.75±14.21 dB HL preoperatively, 37.50±17.39 dB HL 1 year postoperatively and 27.50±13.20 dB HL at least 2 years postoperatively. For TORP mean air-bone gap (ABG) was 35.00±10.70 dB before surgery, 1 year after surgery 25.63±13.01 dB and at least 2 years postoperatively 24.13±14.04 dB. In the PORP population mean air-bone gap (ABG) was 30.75±9.50 dB before surgery, 1 year after surgery 20.50±10.33 dB and at least 2 years postoperatively 12.50±5.52 dB. In the whole group 10 out of 15 cases (67%) showed a postoperative ABG of less than 20 dB. Conclusions: Ossicular disruption can be caused by multiple factors. Hearing results after immediate or delayed ossiculoplasty are apparently satisfying, although late cases are assumed to be associated with adhesion, cholesteatoma or fibrosis. [ABSTRACT FROM AUTHOR]