Evaluation of hearing outcomes in ossicular chain reconstruction: A comparison between total and partial ossicular replacement prostheses.

Abstract

Objective: To evaluate and compare postoperative hearing outcomes in patients who have undergone ossicular chain reconstruction using partial and total ossicular replacement prostheses. Study Design: Prospective Non-randomized Clinical study. Setting: Department of Otorhinolaryngology, Shifa International Hospital, Islamabad. Period: April 2024 to April 2025. Methods: Patients undergoing ossiculoplasty were enrolled consecutively and categorized into two groups based on prosthesis used: total ossicular replacement prosthesis (TORP) and partial ossicular replacement prosthesis (PORP). The selection of prosthesis was determined intraoperatively based on extent of ossicular chain damage. All patients were followed post-operatively. Pre-operative and post-operative hearing thresholds were assessed using pure tone audiometry. Results: The TORP group had a higher preoperative air-bone gap (ABG) at 31.77 ± 10.05 dB, compared to the PORP group at 26.31 ± 10.67 dB. After surgery, ABG improved in both groups, reaching 17.54 ± 10.83 dB in the TORP group and 19.69 ± 10.34 dB in the PORP group. Both results met the criteria for successful ossiculoplasty. The analysis within the TORP group showed significant hearing improvement, with a p-value of less than 0.01. This group had a mean ABG gain of 14.23 dB and a large effect size. In contrast, the PORP group showed a moderate improvement of 6.62 dB, with a p-value of 0.05. However, the differences between the two groups were not statistically significant, with a p-value of 0.185 and a Hedges’ g effect size of -0.519 favoring TORP. Conclusion: Both TORP and PORP effectively treat conductive hearing loss. TORP may provide more benefit for patients with severe preoperative hearing loss or significant ossicular damage. Choosing a prosthesis should depend on what is found during the operation instead of past practices.