Comparison of Effectiveness of Septal cartilage and Grommet as Partial Ossicular Replacement Prostheses

Abstract

Background: Ossiculoplasty is the reconstruction of the middle ear ossicular chain. Hearing improvement largely depends on mechanical stability and bio-compatibility of  prosthesis used.

Aim and objectives: To evaluate and compare hearing improvement after type III tympanoplasty with ossiculoplasty using septal cartilage and grommet.

Methodology: This was a prospective study conducted on 62 Chronic Otitis Media (COM) patients who underwent type III tympanoplasty with ossiculoplasty. Patients in the age group of 18 years to 50 years and with conductive hearing loss of 45 dB to 60 dB with an air-bone (AB) gap of more than 45 dB, were included. Patients were randomly divided into two groups. Group A had ossiculoplasty with septal cartilage while Group B had it with grommet as the prosthesis. The outcome was measured using Pure Tone Audiometry (PTA), in terms of postoperative hearing gain and AB gap reduction at 3 months and 6 months.

Results: Mean age of the study population was 34.84±11.396 years, with male-to-female ratio 1: 1.07. Left ear was the most operated one. Major complaints were hearing loss and ear discharge. Squamosal disease was present in 62.9% of patients. Incus was the most involved ear ossicle. Mean PTA in both groups showed significant improvement when compared pre- and postoperatively. A comparison between the two study groups in terms of AB gap reduction and hearing gain pre- and postoperatively didn't reveal any statistically significant differences. Most common postoperative complication was secondary perforation. Extrusion was present in 3 patients of Group B.

Conclusion: Grommet can be an effective ossicular prosthesis with hearing outcomes and complications comparable to conventional grafts such as septal cartilage.