Ossiculoplasty with presculpted banked cartilage

The goal of ossiculoplasty is restoration of conductive hearing impairments with long-term stability. This clinical study attempts to evaluate the effectiveness of ossiculoplasty in 187 ears using homologous, costochondral cartilage. The cartilage was presculpted into a total ossicular replacement prosthesis (TORP configuration) or partial ossicular replacement prosthesis (PORP configuration) by a tissue bank and stored for later use. These preformed transplants were further shaped in the operating room depending on the anatomic findings during tympanoplasty. Thin Silastic® sheeting was often used when middle ear mucosa was severely diseased. The postoperative hearing results as determined by the air-bone gap were comparable with those obtained with synthetic alloplastic materials (mean gap, 16.9 dB), which was a statistically significant improvement over the preoperative levels, with a mean of 37.2 dB. However, unlike synthetic materials, no extrusions occurred. Hearing results in TORP configuration were equally favorable as those in PORP configuration. Middle ear inflammation had no deleterious effect on hearing results. The use of banked, presculpted homologous cartilage in TORP and PORP configurations appears to be a safe and efficacious alternative for ossicular reconstruction.