Optimizing Hearing Outcomes in Middle Ear Surgery: A Comparative Analysis of Titanium (PORP) Against Autologous Incus in Type IIb Tympanoplasty

The aim of the study is to compare the hearing improvement using Titanium prosthesis (PORP) against autologous incus in Type IIb Tympanoplasty. A prospective study was done for patients of chronic otitis media having ossicular discontinuity with necrosed lenticular process during surgery. It includes 115 patients of which 61 underwent ossicular reconstruction with titanium (PORP) and 54 with refashioned autologous incus during the period 2015-2023 (8 years). Pure tone Audiometry was done post-operatively at 1, 3, and 6 months. Air-Bone Gap (ABG) improvement was recorded as recommended by AAO-HNS (at 0.5,1,2,3 kHz) to assess hearing improvement and results were compared. The hearing improvement was analyzed by comparing the Air-Bone Gap and hearing loss before and after surgery. There was a significant hearing improvement in both groups. However, there was no statistically significant difference in hearing improvement between the two groups.As per AAO-HNS guidelines, a success outcome is defined as a of post-operative Air-Bone gap of less than20 dB. The success outcome in our study was found to be-Titanium prosthesis (PORP) - 73.77% (45/61patients) Autologous incus- 57.41% (31/54patients). Autologous incus is commonly used ossicular remnant for reconstruction with promising results in literature. In our study, titanium prosthesis also showed similar statistical significant improvement in hearing. Reconstruction using titanium prosthesis showed better results in-terms of percentile than autologous incus in AB gap closure.