Titanium Ossicular Chain Reconstruction Revision Success and Preoperative Factors Predicting Success

Objective. Determine rates of success after revision titanium ossicular chain reconstruction with either partial or total ossicular replacement prosthesis and assess preoperative factors predicting positive outcomes. Study Design. Case series with planned data collection. Setting. Tertiary hospital. Subjects and Methods. The charts of 76 surgical patients who underwent revision titanium ossicular chain reconstruction from 2003 to 2014 were abstracted from a prospectively maintained database at the Medical University of South Carolina. Postoperative air-bone gap (ABG) after revision surgery at short-term (<6 months) and intermediate to long-term (>1 year) follow-up and preoperative factors associated with postoperative ABG <= 20 dB were recorded. A paired t test or Wilcoxon signed-rank sum test was utilized to compare preoperative, short-term, or intermediate to long-term results. Results. Seventy-six patients underwent revision ossiculoplasty and met inclusion criteria. Mean postoperative ABG was 22.5 at short-term follow-up (P<.0001) and 24.4 at intermediate to long-term follow-up (P =.003). Postoperative ABG <= 20 dB was achieved in 51.5% of patients. The only preoperative factor associated with postoperative ABG <= 20 dB was location of original primary ossiculoplasty (P =.01). Conclusions. This is one of the larger studies involving revision titanium ossiculoplasty. Revision surgery showed a significant improvement in postoperative ABG. The location of the original ossiculoplasty correlated with success of revision surgery (defined as postoperative ABG <= 20 dB). Patients who had the primary ossiculoplasty at an outside hospital may have better audiometric outcomes than patients who had it at a tertiary hospital.