Journal Reading

The Effect Of Age On Ossiculoplasty Results: A Retrospective

Evaluation Of 60 Cases

Presentator : dr. Vidya Dwi Astari Pasaribu

Advisor : Dr. dr. Devira Zahara, M. Ked(ORL-HNS), Sp. T.H.T.K.L. (K)
Moderator : dr. Carlo Maulana Akbar, M.Ked (ORL-HNS), Sp. T.H.T.K.L
Assessors : 1. Dr. dr. Harry .A. Asroel, M.Ked, Sp.T.H.T.K.L. (K)
2. Dr. dr. HR Yusa Herwanto, M. Ked (ORL-HNS),
Sp.T.H.T.K.L. (K)
Day/Date : Thursday / November18th 2021
Time : 09.00 am - 10.00 am WIB
Place : Daring Via Zoom

OTORHINOLARYNGOLOGY - HEAD AND NECK SURGERY

DEPARTMENT
FACULTY OF MEDICINE
UNIVERSITAS SUMATERA UTARA
MEDAN
2021
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Auris Nasus Larynx xxx (2019) xxx–xxx

Contents lists available at ScienceDirect

Auris Nasus Larynx

journal homepage: www.elsevier.com/locate/anl

The effect of age on ossiculoplasty results: A retrospective

evaluation of 60 cases
Kadir Özdamar a,1, Alper Şen b,*
a
Private Şanmed Hospital, Department of Otorhinolaryngology — Head and Neck Surgery, Şanlıurfa, Turkey
b
Harran University, Medical Faculty, Department of Otorhinolaryngology — Head and Neck Surgery, Şanlıurfa, Turkey

A R T I C L E I N F O A B S T R A C T

Article history: Objective: There are only a few studies evaluating ossiculoplasty results in the pediatric age group.
Received 18 March 2019 Although the effect of different factors on the results of ossiculoplasty is investigated, the effect of
Accepted 12 August 2019 age on ossiculoplasty results is not known. In this study, the effect of age on ossiculoplasty results
Available online xxx
has been investigated.
Methods: This retrospective clinical study was performed in 60 patients (30 female, 30 male; mean age
Keywords:
15.5  14.3 years, range 9–57 years) who underwent ossiculoplasty. The cases were divided into two
Ossiculoplasty
Pediatric
groups according to their age. Group A consisted of pediatric cases younger than 18 years of age and
Adults group B consisted of adult subjects (>18 years). The comparison of the groups was made by taking into
Age consideration the air-bone gap in the 3rd and 12th weeks of the pre- and postoperative period.
Long term results Results: There was no statistically significant difference between preoperative air-bone gaps of the
groups (p = 0.086). In the third postoperative month, the air-bone gap gain of group A was
statistically significantly higher than group B (p = 0.0001). The air-bone gap gain of group A was
significantly higher than group B in the postoperative 12th month (p = 0.026). The air-bone gap gain
of the patients with malleus in group A and group B was higher in the postoperative 3rd month than
in the patients without malleus (all p values <0.05). There was no statistically significant difference
between the air-bone gap gain in patients with the stapes suprastructure and the air-bone gap gain of
the patients without stapes suprastructure in group A and group B in the postoperative 3rd month (p
values >0.05).
Conclusion: The results of ossiculoplasty were found better in the pediatric age group. We think
that ossiculoplasty should be carried out without delay in the pediatric age group.
© 2019 Elsevier B.V. All rights reserved.

1. Introduction to be applied in literature since 1900s and by means of

Ossiculoplasty, which is one of the most current issues in
otology, provides the restoration of hearing. It has been started
* Corresponding author at: Harran Tıp Fakültesi Araştırma ve Uygulama
Hastanesi, Mardin Yolu 22 Km Osmanbey Kampüsü, Şanliurfa, Turkey.
E-mail addresses: drkadirozdamar@hotmail.com (K. Özdamar),
dralpersen@gmail.com (A. Şen).
1
Harran Tıp Fakültesi Araştırma ve Uygulama Hastanesi, Mardin Yolu
22 Km Osmanbey Kampüsü, Şanliurfa, Turkey.
https://doi.org/10.1016/j.anl.2019.08.006
0385-8146/© 2019 Elsevier B.V. All rights reserved.
technological and medical developments, it has become one of
the main surgeries of modern otology [1,2].
There are many factors affecting the success of ossiculo-
plasty. The studies have shown the factors which affect the
success of ossiculoplasty. The experience of the surgeon, the
state of the ossicles, middle ear pathologies, the level of hearing
loss, and the materials used in reconstruction are the main
factors affecting the success of ossiculoplasty [3,4]. The
surgeon must have an opinion about the prognostic factors to
increase the success and predict the possible outcomes.

Please cite this article in press as: Özdamar K, Şen A. The effect of age on ossiculoplasty results: A retrospective evaluation of 60 cases. Auris
Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.08.006
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Different techniques have been reported in the literature
which are used in ossiculoplasty [5,6]. Current ossiculoplasty
techniques are usually demonstrated by trial and error
methods. Each study has contributed to a better understanding
on the effects of ossicular chain reconstruction and hearing
recovery.
There is no consensus in the literature about at which age
ossiculoplasty will be applied. There are only a few studies
evaluating ossiculoplasty results in the pediatric age group.
Moreover, there are relatively few studies about the pediatric
age group reporting otologic surgical technique and the results
of these techniques [7–9]. Although the effect of different
factors on the results of ossiculoplasty is investigated, the effect
of age on ossiculoplasty results is not known. In this study, the
effect of age on ossiculoplasty results has been investigated.
The subjects included in the study were divided into two groups
as pediatric and adult group. Ossiculoplasty hearing results
were compared.
2. Methods
This retrospective clinical study was performed in 60 patients
(30 women, 30 men; mean age 15.5  14.3 years, range 9–57
years) who underwent ossiculoplasty between January
2015 and December 2017 in the Department of Otolaryngology.
The study was approved by the local ethics committee (ethical
committee number:E.16097/04-05.04.2018). The study was
carried out in accordance with the guidelines of the Helsinki
Declaration and Good Clinical Practice.
Patients with chronic otitis media who underwent ossicular
chain repair with cartilage tympanoplasty were included in the
study. Patients with sensory hearing loss, previous ossiculo-
plasty or middle ear surgery, normal tympanic membrane,
fixed stapes footplate and otosclerosis were excluded from the
study.
Age, gender, operative ear, tympanic membrane perforation
size, middle ear pathology and status, preoperative and
postoperative audiological test results and follow-up periods
of the cases were recorded. This information was obtained by
scanning the files of the patients in the hospital registry system.
The middle ear status of the patients was evaluated using the
middle ear risk index (MERI) which was previously developed
by Kartush [10]. Tympanic membrane perforations were
classified as total (100%), subtotal (>50%) and less than
50% (middle).
All patients were followed up for at least 12 months before
surgery. All patients underwent computed tomography and
audiologic examination. All patients were operated by the
same surgeon under general anesthesia in accordance with
well-known principles of ear surgery. Tympanoplasty with a
retroauricular incision was performed to all patients. Tragal
cartilage was used as a graft in tympanoplasty. Tragal cartilage
was used without dilution, after it was adapted to the
perforation size. Mastoidectomy was not performed to any
cases. No cholesteatoma or cholesterol granuloma was
detected in any cases. Incus interposition, incudostapedial
bone cement or titanium partial ossicular replacement
prosthesis (PORP; Heinz Kurz GmbH Medizintechnik1,
Please cite this article in press as: Özdamar K, Şen A. The effect of age on ossiculoplasty results: A retrospective evaluation of 60 cases. Auris
Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.08.006
Dusslingen, Germany) were performed in patients with stapes
suprastructure. Total ossicular replacement prosthesis (TORP;
Heinz Kurz GmbH Medizintechnik1, Dusslingen, Germany)
was performed in cases without stapes suprastructure. The
tragal cartilage was placed in the lateral side of the malleus to
the medial of the annulus with over-underlay technique [11] in
accordance with the perforation size. The graft was supported
with gelfoam after the tympanomeatal flap was reposized. On
the first postoperative day, the patients were discharged with
local and systemic antibiotherapy. The cases were called for
regular follow-up. Retroauricular sutures were taken in the
postoperative first week. In the third postoperative week,
gelfoams in the external ear canal were cleaned. No
complication developed in any of the cases. Control pure
tone audiometry was performed in the postoperative third and
twelfth month. The cases were divided into two groups
according to their age. Group A consisted of pediatric cases
younger than 18 years of age and group B consisted of adult
subjects (>18 years). The sample size was calculated
according to the estimated sample size formula for cross-
sectional studies [12]. The number of cases taken for each
group was determined as 5% Error, 80% Power and Standard
Effect Size 0.92. At least 24 cases should have been taken into
each group. 30 subjects were included in each group.
The comparison of the groups was made by taking into
consideration the air-bone gap in the 3rd and 12th weeks of the
pre- and postoperative period. The intact of the tympanic
membrane without retraction or lateralization and the air-bone
gap (ABG) lower than 20 dB have been evaluated as success
criteria. ABG was calculated by taking the average of four
frequencies (0.5, 1, 2 and 4 kHz).
2.1. Statistical analysis
For statistical analysis, NCSS (NumberCruncher Statistical
System) 2007 (Kaysville, Utah, USA) program was used.
Descriptive statistical methods (mean, standard deviation,
median, frequency, ratio, minimum, maximum) were used to
evaluate the study data. Student t Test was used to compare the
quantitative data showing normal distribution in two groups,
Mann Whitney U test was used to compare the variables which
did not show normal distribution. Paired Samples test was used
for postop according to preop. Pearson’s Chi-Square test and
Fisher Freeman Halton test were used to compare qualitative
data. The significance was evaluated at p < 0.05.
3. Results
No statistically significant difference was observed between
group A and group B in terms of gender, side, tympanic
membrane perforation size, MERI score and graft type
distribution (all p values >0.05) (Table 1).
No statistically significant difference was found between
group A and group B in terms of the intraoperative middle ear
findings (all p values >0.05) (Table 2). Type of ossiculoplasty
in each group was shown in Table 3. There was no statistically
significiant difference between the success of PORP and TORP
of the groups (all p values >0.05).
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Table 1
Demographic data of groups.

Group A (pediatric cases) Group B (adults cases) p

Aver  S.D./n-% Median Aver.  S.D./n-% Median
Age (years) 9.5  1.1 9.0 33.3  11.1 34.5 0.0001 t
X2
Gender Female 15.0 50.0% 15.0 50.0% 1.000
Male 15.0 50.0% 15.0 50.0%
X2
Perforation size Subtotal (>50) 27 90.0% 27 90.0% 1.000
Total (%100) 3 10.0% 3 10.0%
X2
The side operated Right 11 36.7% 16 53.3% 0.194
Left 19 63.3% 14 46.7%
X2
MERI score Mild 3 10.0% 1 3.3% 0.514
Moderate 14 46.7% 17 56.7%
Severe 13 43.3% 12 40.0%
t X2
t test / Chi-square test.

Table 2
Comparison of intraoperatif middle ear findings between each group.
*
Group A (n:30) Group B (n:30) p
Malleus Normal 17 (56.7%) 19 (63.3%) 0.522
Absent 13 (43.3%) 11 (36.7%)
Incus Absent 3 (10.0%) 7 (23.3%) 0.229
Defective 17 (56.7%) 15 (50.0%)
Normal 11 (33.3%) 8 (26.7%)
Stapes Normal 12 (40.0%) 7 (23.3%) 0.176
Suprastructure defective 18 (60.0%) 23 (76.7%)
Middle ear mucosa Normal 2 (6.7%) 1 (3.3%) 0.062
Hypertrofic mucosa 8 (26.7%) 9 (30.0%)
Fibrosis and atrofic mucosa 3 (10.0%) 5 (16.7%)
Sclerotic mucosa 2 (2.7%) 6 (20.0%)
Granulation 16 (53.9%) 9 (30.0%)
*
Chi-square test.

There was no statistically significant difference between group A and group B in the postoperative 3rd and 12th month (p
preoperative air-bone gaps of the groups (p = 0.086). In the values >0.05) (Table 5).
third postoperative month, the air-bone gap gain of group A was Graft retention success was 96.6% in Group A while it was
statistically significantly higher than group B (p = 0.026). The 93.3% in Group B. There was no statistically significant
air-bone gap gain of group A was significantly higher than difference between the groups in terms of graft retention
group B in the postoperative 12th month (p = 0.033) (Table 4). success (p = 0.424).
The air-bone gap gain of the patients with malleus in group A
and group B was higher in the postoperative 3rd and 12th month 4. Discussion
than in the patients without malleus (all p values <0.05). There
was no statistically significant difference between the air-bone In this study, the effect of age on ossiculoplasty results was
gap gain in patients with the stapes suprastructure and the air- evaluated. In the pediatric age group, a better improvement has
bone gap gain of the patients without stapes suprastructure in been observed in ossiculoplasty hearing levels compared to the
adults. The prognostic significance of the presence of malleus
for ossiculoplasty results are valid for both age groups, and it
Table 3
has been observed that stapes suprastructure has had no
Type of ossiculoplasty in each group. prognostic significance for ossiculoplasty.
*
There are relatively few studies in the literature which have
Type of ossiculoplasty Group A Group B p
(N:30) (N:30)
published the results of ossiculoplasty. Ossiculoplasty is one of
the current topics in otology and there are still unexplained
Partial ossicular replacement 8 4 0.104
subjects. The fact that the results of ossiculoplasty are affected
prosthesis (PORP) 75.0% 75.0%
Total ossicular replacement 18 23 0.228 by many factors prevents a common consensus on ossiculo-
prosthesis (TORP) 66.6% 65.2% plasty results and its prognostic factors. Recent literature
Incus interposition 1 2 information shows that there is no common prognostic system
Incudostapedial bone cement 3 1 which evaluates the prognostic factors for ossiculoplasty yet.
*
Chi-square test. A proven risk classification index provides an accurate

Please cite this article in press as: Özdamar K, Şen A. The effect of age on ossiculoplasty results: A retrospective evaluation of 60 cases. Auris
Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.08.006
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Table 4 ossiculoplasty results of the groups. However, they have

Comparison of air-bone gap and the hearing gains between the two groups pre- reported a deterioration in the transition from groups 1 to
and postoperatively.
3. Dornhoffer [1] has stated that the condition of the middle ear
ABG (dB) Group A Group B p mucosa affects the results of ossiculoplasty.
(N:30) (N:30) Black [15] has reported that the middle ear mucosa is a
Preoperative 40.0  6.8 35.6  12.7 0.086b prognostic factor for postoperative hearing outcome. SPITE
Postoperative 3rd 15.6  10.1 14.7  8.7 0.965b classification, which distinguishes the prognostic factors of
c
p 0.0001* 0.0001* ossiculoplasty from surgery, prosthetics, infection, tissue and
Postoperative 12th 14.2  11.3 15.1  7.9 0.062b
d
p 0.0001* 0.0001*
eustachian factors, has been developed by Black [15].
ABG gain at postoperative 3rd 24.4  8.4 20.8  11.7 0.026b While Albu et al. [16] have reported that the results of simple
ABG gain at postoperative 12th 25.8  7.6 20.5  9.7 0.033b otitis media, granulated otitis media, and otitis media with
e
p 0.308 0.416 cholesteatoma are even worse. Brackmann et al. [17] have not
Abbreviations: ABG, Air-Bone Gap. reported similar results. Yung et al. [2] have stated that the
a
p Paired Samples test. presence of the malleus head is the most important factor in
b
Mann–Whitney u test. ossiculoplasty long-term results.
c
p; Comparison of preoperative and postoperative 3rd month ABG values.
d A classification was made according to the middle ear risk
p; Comparison of preoperative and postoperative 12th month ABG values.
e
p; Comparison fo ABG gain at postoperative 3rd and 12th month. index classification defined by Kartush [10] considering
*
p < 0.01. otorrhea, the state of the ossicles, the presence of tympanic
membrane perforation, the presence of cholesteatoma, revision
surgery status, presence of middle ear effusion and smoking. In
this study, MERI index developed by Kartush [10] has been
comparison between different surgical techniques. It will used to evaluate middle ear risk factors. We think that it
contribute to the correct analysis of the studies. The use of a provides a more detailed and accurate evaluation of the cases.
universal risk classification system will contribute in particular The success rates of the patients with low scores have been
to otologic surgery education. Knowledgeable and experienced found higher compared to the MERI index, while the success
on prognostic risk factors, the otologists will provide patients rate has been lower in cases with high MERI scores. In
with more accurate and satisfactory information about ossiculoplasty success, well-examined prognostic factors will
ossiculoplasty results. contribute to the achievement of successful results. Therefore,
In the literature, there are many classifications which we think that MERI index should be used for the evaluation of
evaluate the prognostic factors of ossiculoplasty. Austin [13] ossiculoplasty results.
has developed a system that describes the ossicular condition of There is not enough information about age appropriateness
the diseased ear and considers the absence of malleus as an for ossiculoplasty in the literature. While some authors suggest
important risk factor for ossiculoplasty. In the classification that a certain age should be waited for surgery, some authors
made by Belluci [14], ossiculoplasty has been evaluated in four argue that tympanoplasty should be performed without delay in
groups according to the degree of otorrhea and nasopharyngeal order to prevent chronic otitis media complications [18].
malformations. According to the Belluci classification, the Although there is no study about this subject on ossiculoplasty,
results of ossiculoplasty in patients with persistent suppuration there is not enough study about ossiculoplasty, either. In this
and cleft palate defects have been reported rather bad [14]. study, pediatric and adult cases who have had ossiculoplasty
Dornhoffer [1], in the Belluci classification, has reported that with tympanoplasty were divided into two groups. In our study,
there is no statistically significant difference between the the ossicular destruction rate was relatively high. Even though

Table 5
Comparison ABG gains of each groups in terms of the presence of the Malleus and the Stapes.

Group A Group B
Malleus p
a
Malleus a
p
Normal (N:17) Absent (N:13) Normal (N:19) Absent (N:11)
Postoperative 3rd month ABG gain (dB) 25.8  10.2 24.1  8.4 0.0001* 21.4  11.8 19.2  9.8 0.0001*
Postoperative 12th month ABG gain (dB) 27.4  8.8 22.9  8.6 0.0001* 21.2  10.2 18.9  8.4 0.0001*
a
p 0.252 0.068 0.426 0.228
Stapes p
a
Stapes a
p
Normal (N:12) Defective (N:18) Normal (N:7) Defective (N:23)
Postoperative 3rd month ABG gain (dB) 22.8  9.2 25.8  6.6 0.056 20.4  13.2 21.6  11.2 0.102
Postoperative 12th month ABG gain (dB) 23.2  8.8 26.2  9.3 0.062 19.8  8.4 22.0  8.1 0.068
a
p 0.116 0.314 0.108 0.606
Abbreviations: ABG, Air-Bone Gap.
a
Paired samples test.
*
p < 0.01.

Please cite this article in press as: Özdamar K, Şen A. The effect of age on ossiculoplasty results: A retrospective evaluation of 60 cases. Auris
Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.08.006
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we did not know the exact reason of this condition in our
patients, the frequency of cronic otitis media, the prolonged
infections in middle ear and the non-compliance of patients
with medical treatment were blamed for this results. The MERI
score of the cases was calculated. Better ossiculoplasty results
were seen in pediatric patients. As possible causes, it may be
thought that the pathologies such as sclerotic plaque,
granulation tissue and fibrotic band due to chronic otitis media
are less in these cases. Although the results of ossiculoplasty
and tympanoplasty are thought to be worse in the pediatric cases
due to the fact that the eustachian tube anatomy is more
horizontal and shorter than the adult cases and the postoperative
care is more challenging, the prolongation of chronic otitis
media, the changes in the middle ear mucosa and structures may
lead to worsening in the success of ossiculoplasty and
tympanoplasty in the elderly. In addition, partial hearing loss
in pediatric cases causes decline in speaking, neurological
development and school performance [19,20]. Delaying
ossiculoplasty will lead to a decrease in the success of surgery
in the adult age group and also to an undesirable condition in
pediatric cases. Having considered the data of this study, the
results of pediatric ossiculoplasty are better in the adult age
group. We believe that ossiculoplasty should not be delayed in
the pediatric age group.
Importance of the presence of individual ossicle in the
success of ossiculoplasty remains controversial issues in
literature. Presence of malleus has a predictive value in the
success of ossiculoplasty because of its position. Several
authors declared that presence of malleus has a valuable
prognostic factors in ossiculoplasty success [21–23]. Other-
wise, prognostic values of the presence of stapes suprastructure
remains controversial issue in ossiculoplasty. In the present
study, we observed that the presence of malleus is a valuable
predictor for ossiculoplasties success.
Although this study provides important information, it has
some limitations. The relatively low number of cases and the
retrospective design of the study are among the main
limitations. The relatively long follow-up time ensures more
reliable study results. There is a requirement to validate the
data of this study with a prospective studies including more
patients.
5. Conclusion
In this study, the effect of age on ossiculoplasty results was
evaluated. The results of ossiculoplasty were found better in the
pediatric age group. We think that ossiculoplasty should be
carried out without delay in the pediatric age group. Prospective
studies with more patients are required.
Ethical approval
The study was carried out in accordance with the Principles
of the Declaration of Helsinki and Guideline for Good Clinical
Practices. The study was approved by the Board of Ethics for
clinical research of the same university (Board of Ethics’
decision no: E.16097/04 date: 05/04/2018).
Please cite this article in press as: Özdamar K, Şen A. The effect of age on ossiculoplasty results: A retrospective evaluation of 60 cases. Auris
Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.08.006
5
Informed consent
Informed consent was no obtained from all participants
included in this study because of the retrospective study design
Financial disclosure
The study received no external financial support.
Conflictof interest
No author has any potential conflict of interest.
References
[1] Dornhoffer JL, Gardner E. Prognostic factors in ossiculoplasty: a
statistical staging system. Otol Neurotol 2001;22:299–304.
[2] Yung M. Long-term results of ossiculoplasty: reasons for surgical
failure. Otol Neurotol 2006;27:20–6.
[3] Chavan SS, Jain PV, Vedi JN, Rai DK, Kadri H. Ossiculoplasty: a
prospective study of 80 cases. Iran J Otorhinolaryngol 2014;26(July
(76)):143–50.
[4] Murphy TP. Hearing results in pediatric patients with chronic otitis
media after ossicular reconstruction with partial ossicular replacement
prostheses and total ossicular replacement prostheses. Laryngoscope
2000;110(April (4)):536–44.
[5] Bartel R, Cruellas F, Hamdan M, Gonzalez-Compta X, Cisa E,
Domenech I, et al. Hearing results after type III tympanoplasty: incus
transposition versus PORP. A systematic review. Acta Otolaryngol
2018;138(July (7)):617–20.
[6] Mudhol RS, Naragund AI, Shruthi VS. Ossiculoplasty: revisited.
Indian J Otolaryngol Head Neck Surg 2013;65(December (Suppl.
3)):451–4.
[7] Atan D, Dere H, Yamur AR, Özcan KM. Results of ossicular chain
reconstruction with glass ionomer cement in pediatric patients. Int J
Pediatr Otorhinolaryngol 2016;85(June):103–6.
[8] Vincent R, Wegner I, Derks LS, Grolman W. Congenital ossicular
chain malformations with mobile stapes in children: results in 17 cases.
Laryngoscope 2016;126(March (3)):682–8.
[9] Wolter NE, Holler T, Cushing SL, Chadha NK, Gordon KA, James AL,
et al. Pediatric ossiculoplasty with titanium total ossicular replacement
prosthesis. Laryngoscope 2015;125(March (3)):740–5.
[10] Kartush JM. Ossicular chain reconstruction. Capitulum to malleus.
Otolaryngol Clin North Am 1994;27(4):689–715.
[11] Kartush JM, Michaelides EM, Becvarovski Z, LaRouere MJ. Over-
under tympanoplasty. Laryngoscope 2002;112(May (5)):802–7.
[12] Kelsey J, Whittemore A, Evans A, Thompson W. Methods of sampling
and estimation of sample size. Methods Observational Epidemiol
1996;311–40.
[13] Austin DF. Ossicular reconstruction. Otolaryngol Clin North Am
1972;5:145–60.
[14] Bellucci RJ. Selection of cases and classification of tympanoplasty.
Otolaryngol Clin North Am 1989;22(5):911–26.
[15] Black B. Ossiculoplasty prognosis: the SPITE method of assessment.
Am J Otol 1992;13(6):544–51.
[16] Albu S, Babighian G, Trabalzini F. Prognostic factors in tympano-
plasty. Am J Otol 1998;19(2):136–40.
[17] Brackmann DE, Sheehy JL, Luxford WM. TORPs and PORPs in
tympanoplasty: a review of 1042 operations. Otolaryngol Head Neck
Surg 1984;92:32–7.
[18] Yegin Y, Çelik M, Koç AK, Küfeciler L, Elbistanlı MS, Kayhan FT.
Comparison of temporalis fascia muscle and full-thickness cartilage
grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol
2016;82(November–December (6)):695–701.
[19] Kaya I, Benzer M, Gode S, Sahin F, Bilgen C, Kirazli T. Pediatric type
1 cartilage tympanoplasty outcomes: a comparison of short and long
term hearing results. Auris Nasus Larynx 2018;45(August (4)):722–7.
G Model
ANL-2648; No. of Pages 6

6 K. Özdamar, A. Şen / Auris Nasus Larynx xxx (2019) xxx–xxx

[20] Yegin Y, Çelik M, Altintaş A, Çolak C, Kayhan FT. Do the angle and
length of the eustachian tube affect the success rate of pediatric cartilage
type 1 tympanoplasty? J Craniofac Surg 2017;28(May (3)):e227–31.
[21] De Vos C, Gersdorff M, Gérard JM. Prognostic factors in ossiculo-
plasty. Otol Neurotol 2006;28:61–7.
[22] Yung M, Vowler S. Long-term results in ossiculoplasty: an analysis of
prognostic factors. Otol Neurotol 2006;27:874–81.
[23] Bared A, Angeli SI. Malleus handle: determinant of success in
ossiculoplasty. Am J Otol 2010;31:235–40.

Please cite this article in press as: Özdamar K, Şen A. The effect of age on ossiculoplasty results: A retrospective evaluation of 60 cases. Auris
Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.08.006
 PENGARUH USIA TERHADAP HASIL OSIKULOPLASTI: SEBUAH EVALUASI
RETROSPEKTIF PADA 60 KASUS

ABSTRAK
Objektif: Hanya ada beberapa penelitian yang mengevaluasi hasil osikuloplasti pada
usia kelompok pediatri. Meskipun efek dari berbagai faktor pada hasil osikuloplasti
diselidiki, namun pengaruh usia pada hasil osikuloplasti tidak diketahui. Dalam penelitian
ini, pengaruh usia pada hasil osikuloplasti telah diinvestigasi.
Metode: Studi klinis retrospektif ini dilakukan pada 60 pasien (30 perempuan, 30 laki-
laki; usia rata-rata 15,5 ± 14,3 tahun, kisaran 9-57 tahun) yang menjalani osikuloplasti.
Kasus-kasus tersebut dibagi menjadi dua kelompok berdasarkan usia partisipan.
Kelompok A terdiri dari kasus pediatri yang lebih muda dari 18 tahun dan kelompok B
terdiri dari subyek dewasa (>18 tahun). Perbandingan kelompok dibuat dengan
mempertimbangkan celah air-bone pada minggu ke-3 dan ke-12 periode pra dan post
operasi.
Hasil: Tidak ada perbedaan yang signifikan secara statistik antara celah air-bone pra
operasi dari kedua kelompok (p = 0,086). Pada bulan ketiga pasca operasi, kenaikan
celah air-bone kelompok A secara statistik lebih tinggi secara signifikan daripada
kelompok B (p = 0,0001). Kenaikan celah air-bone kelompok A secara signifikan lebih
tinggi dari kelompok B pada bulan ke-12 pasca operasi (p = 0,026). Kenaikan celah air-
bone pasien dengan malleus pada kelompok A dan kelompok B lebih tinggi pada bulan
ke-3 pasca operasi dibandingkan pada pasien tanpa malleus (semua nilai p <0,05).
Tidak ada perbedaan yang signifikan secara statistik antara peningkatan celah air-bone
pada pasien dengan suprastruktur stapes dan peningkatan celah air-bone pada pasien
tanpa suprastruktur stapes pada kelompok A dan grup B pada bulan ke-3 pasca operasi
(nilai p >0,05).
Kesimpulan: Hasil osikuloplasti ditemukan lebih baik pada kelompok usia pediatri. Kami
memperkirakan bahwa osikuloplasti harus dilakukan tanpa penundaan pada kelompok
usia pediatri.

1. PENGANTAR
Osikuloplasti, yang merupakan salah satu masalah terkini dalam otologi, dapat
memberikan perbaikan pada pendengaran. Hal tersebut mulai diaplikasikan dalam

1
literatur sejak tahun 1900-an dan melalui perkembangan teknologi dan medis, telah
menjadi salah satu operasi utama otologi yang modern.
Ada banyak faktor yang mempengaruhi keberhasilan osikuloplasti. Penelitian telah
menunjukkan faktor-faktor yang mempengaruhi keberhasilan osikuloplasti. Pengalaman
ahli bedah, keadaan osikulus, patologi aurikula media, tingkat gangguan pendengaran,
dan bahan yang digunakan dalam rekonstruksi merupakan faktor utama yang
mempengaruhi keberhasilan suatu osikuloplasti. Para ahli bedah harus berpendapat
tentang faktor faktor prognostik untuk meningkatkan keberhasilan dan memprediksi
kemungkinan hasilnya.
Teknik-teknik yang berbeda yang digunakan dalam osikuloplasti telah dilaporkan
dalam beberapa literatur. Teknik osikuloplasti saat ini biasanya didemonstrasikan
melalui metode trial and error. Setiap penelitian telah berkontribusi pada hasil
pemahaman yang lebih baik tentang efek rekonstruksi pada rantai osikular dan
pemulihan pendengaran.
Tidak ada konsensus atau literatur yang membahas tentang usia yang
memungkinkan untuk tindakan osikuloplasti. Hanya ada beberapa penelitian yang
mengevaluasi hasil osikuloplasti pada kelompok usia pediatri. Selain itu, ada sedikit
penelitian tentang kelompok usia pediatri yang melaporkan teknik bedah otologik dan
hasil dari teknik tersebut. Meskipun pengaruh berbagai faktor pada hasil osikuloplasti
sedang diselidiki, pengaruh usia pada hasil osikuloplasti masih belum diketahui. Dalam
penelitian ini, pengaruh usia pada hasil osikuloplasti telah diinvestigasi. Subyek yang
diinklusikan dalam penelitian ini dibagi menjadi dua kelompok yaitu kelompok pediatri
dan kelompok dewasa. Hasil pendengaran dari osikuloplasti kemudian dibandingkan.

2. METODE
Studi klinis retrospektif ini dilakukan pada 60 pasien (30 wanita, 30 pria; usia rata-
rata 15,5±14,3 tahun, kisaran 9-57 tahun) yang menjalani osikuloplasti antara Januari
2015 dan Desember 2017 di Departemen THT. Studi ini disetujui oleh komite etik lokal
(nomor komite etik: E.16097/04-05.04.2018). Penelitian dilakukan sesuai dengan
pedoman Deklarasi Helsinki dan Praktik Klinis yang Baik.
Pasien dengan otitis media kronis yang menjalani perbaikan rantai osikular dengan
timpanoplasti kartilago dilibatkan dalam penelitian ini. Pasien dengan gangguan
pendengaran sensorik, riwayat osikuloplasti sebelumnya atau operasi telinga tengah,

2
membran timpani normal, stapes footplate terfiksasi dan otosklerosis dikeluarkan dari
penelitian.
Usia, jenis kelamin, riwayat operasi telinga, ukuran perforasi membran timpani,
kelainan telinga tengah, hasil tes audiologis pra operasi dan pasca operasi dan periode
follow-up dari kasus dicatat. Informasi ini diperoleh dengan memindai file pasien di
sistem registrasi rumah sakit. Status telinga tengah pasien dievaluasi menggunakan
indeks risiko telinga media (MERI) yang sebelumnya dikembangkan oleh Kartush.
Perforasi membran timpani diklasifikasikan sebagai total (100%), subtotal (>50%) dan
kurang dari 50% (menengah).
Semua pasien diamati setidaknya 12 bulan sebelum operasi. Semua pasien
menjalani pemeriksaan computed tomography dan audiologis. Semua pasien dioperasi
oleh ahli bedah yang sama dengan anestesi umum sesuai dengan prinsip operasi telinga
yang telah diketahui. Timpanoplasti dengan insisi retroauricular dilakukan pada semua
pasien. Kartilago tragal digunakan sebagai graft dalam timpanoplasti. Kartilago tragal
digunakan tanpa dilusi, setelah disesuaikan dengan ukuran perforasi. Mastoidektomi
tidak dilakukan pada kasus manapun. Tidak ada kolesteatoma atau granuloma
kolesterol yang terdeteksi dalam kasus. Interposisi inkus, semen tulang incudostapedial
atau prostesis pengganti tulang pendengaran parsial titanium (PORP; Heinz Kurz GmbH
Medizintechnik1, Dusslingen, Jerman) dilakukan pada pasien dengan suprastruktur
stapes. Prostesis penggantian osikulasi total (TORP; Heinz Kurz GmbH
Medizintechnik1, Dusslingen, Jerman) dilakukan pada kasus tanpa suprastruktur stapes.
Kartilago tragal ditempatkan pada sisi lateral maleus hingga medial anulus dengan teknik
over-underlay sesuai dengan ukuran perforasi. Graft diberi tahanan dengan gelfoam
setelah flap timpanomeatal direposisi. Pada hari pertama pasca operasi, pasien
dipulangkan dengan antibiotik lokal dan sistemik. Kasus-kasus tersebut dihubungi untuk
dilakukanf follow-up secara teratur. Jahitan pada retroauricular dilepas pada minggu
pertama pasca operasi. Pada minggu ketiga pasca operasi, gelfoams di saluran telinga
eksterna dibersihkan. Tidak ada komplikasi yang berkembang pada semua kasus.
Kontrol audiometri nada murni dilakukan pada bulan ketiga dan kedua belas pasca
operasi. Kasus-kasus tersebut dibagi menjadi dua kelompok berdasarkan usia mereka.
Kelompok A terdiri dari kasus pediatri dengan usia yang lebih muda dari 18 tahun dan
kelompok B terdiri dari subyek dewasa (>18 tahun). Ukuran sampel dihitung menurut
estimasi formula pada studi cross-sectional. Jumlah kasus yang diambil untuk setiap

3
kelompok ditentukan sebagai 5% Error, 80% Power dan Standard Effect Size 0.92.
Paling sedikit terdapat 24 kasus yang harus dimasukkan ke dalam setiap kelompok. 30
subjek diinklusikan dalam setiap kelompok.
Perbandingan kelompok dibuat dengan mempertimbangkan celah air-bone pada
minggu ke-3 dan ke-12 periode pra dan pasca operasi. Kondisi intak membran timpani
tanpa retraksi atau lateralisasi dan air-bone gap (ABG) lebih rendah dari 20 dB telah
dievaluasi sebagai kriteria keberhasilan. ABG dihitung dengan mengambil rata-rata dari
empat frekuensi (0,5, 1, 2 dan 4 kHz).

2.1 Analisis statistik

Untuk analisis statistik, digunakan program NCSS (Number Cruncher Statistical System)
2007 (Kaysville, Utah, USA). Metode statistik deskriptif (mean, standar deviasi, median,
frekuensi, rasio, minimum, maksimum) digunakan untuk mengevaluasi data penelitian.
Student t Test digunakan untuk membandingkan data kuantitatif yang berdistribusi
normal pada dua kelompok, Mann Whitney U test digunakan untuk membandingkan
variabel yang tidak berdistribusi normal. Uji Paired Samples digunakan untuk post
operasi sesuai dengan pre operasi. Uji Chi-Square Pearson dan uji Fisher Freeman
Halton digunakan untuk membandingkan data kualitatif. Signifikansi dievaluasi pada p
<0,05.

3. HASIL
Tidak ada perbedaan yang signifikan secara statistik yang diobservasi antara
kelompok A dan kelompok B dalam hal jenis kelamin, sisi operasi, ukuran perforasi
membran timpani, skor MERI dan distribusi tipe graft (semua nilai p>0,05) (Tabel 1).
Tidak ada perbedaan yang signifikan secara statistik yang ditemukan, antara
kelompok A dan kelompok B dalam hal temuan pada telinga tengah secara intraoperatif
(semua nilai p> 0,05) (Tabel 2). Jenis osikuloplasti pada masing-masing kelompok
ditunjukkan pada Tabel 3. Tidak ada perbedaan yang signifikan secara statistik antara
keberhasilan PORP dan TORP kelompok (semua nilai p >0,05).

4
Tabel 1
Data demografik
Group A (Kasus Anak) Group B (Kasus Dewasa) *p
Rata-rata ± S.D/n-% Median Rata-rata ± S.D/n-% Median
Usia (Tahun) 9,5 ± 1,1 9.0 33,3 ± 11,1 34.5 0,0001 t

Jenis Wanita 15,0 50.0% 15,0 50.0% 1,000 X2

Kelamin

Laki laki 15,0 50.0% 15,0 50.0%

Ukuran Subtotal 90.0% 27 90.0% 1,000 X2
Perforasi (>50)
Total
(%100)
Sisi Operasi Kanan 10.0% 3 10.0%
Kiri 36.7% 16 53.3% 0,194 X2
MERI score Mild 63.3% 14 46.7%
Moderate 10.0% 1 3.3% 0,514 X2
Severe 46.7% 17 56.7%
43.3% 12 40.0%

Tabel 2
Perbandingan intraoperatif telinga tengah pada masing masing grup
Grup A (n:30) Grup B (n:30) *p
Maleus Normal 17 (56.7 %) 19 (63,35) 0,522
Absent 13 (43, 3 %) 11 (36,7%)
Inkus Absent 3 (10,0 %) 7 (23,3 %) 0, 229
Defek 17(56,7%) 15 (50, 0 %)
Normal 11 (33,3%) 8 (26,7 %)
Stapes Normal 12 (40,0 %) 7 (23,3 %) 0, 176
Suprastruktur 18 (60, 0 %) 23 (76,7 %)
defek
Mukosa telinga Normal 2 (6,7 %) 1 (3,3%) 0,062
tengah
Hipertrofi mukosa 8 (26, 7 %) 9 (30,0 %)
Fibrosis dan atrofi 3 (10,0 %) 5 (16,7%)
mukosa
Sklerotic mukosa 2 ( 2,7 %) 2 (20,0%)
Granulsi 16 (53,9%) 9 (30,0 %)
*Chi-square test.

Tidak ada perbedaan yang signifikan secara statistik antara celah air-bone pra
operasi dari kedua kelompok (p = 0,086). Pada bulan ketiga pasca operasi, perolehan
celah air-bone kelompok A secara statistik lebih tinggi secara signifikan daripada
kelompok B (p = 0,026). Kenaikan celah air-bone kelompok A secara signifikan lebih
tinggi dari kelompok B pada bulan ke-12 pasca operasi (p = 0,033) (Tabel 4).
Kenaikan celah air-bone pasien dengan malleus pada kelompok A dan kelompok
B lebih tinggi pada bulan ke-3 dan ke-12 pasca operasi dibandingkan pada pasien tanpa
5
malleus (semua nilai p <0,05). Tidak ada perbedaan yang signifikan secara statistik
antara kenaikan celah air-bone pada pasien dengan suprastruktur stapes dan kenaikan
celah air-bone pada pasien tanpa stapes suprastructure pada grup A dan grup B pada
bulan ke-3 dan ke-12 pascaoperasi (nilai p >0,05) ( Tabel 5).
Keberhasilan retensi graft adalah 96,6% di Grup A dan 93,3% di Grup B. Tidak
ada perbedaan yang signifikan secara statistik antara kedua kelompok dalam hal
keberhasilan retensi graft (p = 0,424).

Tabel 3
Tipe Osikuloplasti
Tipe Osikulopalsti Grup A Grup B p
(N: 30) (N : 30)
Partial ossicular 8 4 0, 104
replacement prosthesis
75,0 % 75,0 %
(PORP)
Total ossicular 18 23 0,228
replacement prosthesis
66,6 % 65, 2 %
(TORP)
Incus interposition 1 2
Incudostapedial bone 3 1
cement
* Chi-square test.

4. DISKUSI
Dalam penelitian ini, pengaruh usia pada hasil osikuloplasti dievaluasi. Pada
kelompok usia pediatri, peningkatan yang lebih baik telah diamati pada tingkat
pendengaran setelah osikuloplasti dibandingkan dengan orang dewasa. Signifikansi
prognostik dari adanya maleus untuk hasil osikuloplasti berlaku untuk kedua kelompok
umur, dan telah diamati bahwa suprastruktur stapes tidak memiliki signifikansi prognostik
untuk osikuloplasti.
Ada beberapa literatur yang telah mempublikasikan hasil dari osikuloplasti.
Osikuloplasti adalah salah satu topik yang banyak dibicarakan di otologi dan masih ada
beberapa subjek yang tidak dapat dijelaskan. Fakta bahwa hasil osikuloplasti
dipengaruhi oleh banyak faktor menyulitkan dibentuknya konsensus umum untuk hasil
osikuloplasti dan faktor prognostiknya. Informasi literatur terbaru menunjukkan bahwa
belum ada sistem prognostik umum yang mengevaluasi faktor prognostik untuk
osikuloplasti. Sebuah indeks klasifikasi risiko terbukti dapat memberikan perbandingan
yang akurat antara teknik bedah yang berbeda. Hal ini akan berkontribusi pada analisis
6
studi yang benar. Penggunaan sistem klasifikasi risiko yang universal akan memberikan
sebuah kontribusi, khususnya untuk pendidikan bedah otologi. Dengan memiliki
pengetahuan dan pengalaman tentang faktor risiko prognostik, ahli otologi dapat
memberikan informasi kepada psien yang lebih akurat dan memuaskan tentang hasil
dari okuloplasti.

Tabel 4
Perbandingan air-bone gap dan fungsi pendengaran antara 2 grup pre dan
postoperasi
ABG (9db) Grup A Grup B p
(N: 30) (N: 30)
Preoperatif 40.0 + 6.8 35.6 + 12.7 0.086b
Postoperatif 3rd 15.6 + 10.1 14.7 + 8.7 0.965b
cp 0.0001b 0.0001b
Postoperatif 12th 14.2 + 11.3 15.1 + 7.9 0.062b
dp 0.0001* 0.0001*
ABG gain at postoperative 3rd 24.4 + 8.4 20.8 + 11.7 0.026b
ABG gain postoperative 12th 25.8 + 7.6 20.5 + 9.7 0.033b
ep

0.308 0.416
Singkatan: ABG, Air-Bone Gap.
ap Uji Sampel Berpasangan.
b Uji Mann-Whitney u.
cp; Perbandingan nilai ABG bulan ke-3 pra operasi dan pasca operasi.
hari; Perbandingan nilai ABG bulan ke-12 pra operasi dan pasca operasi.
ep; Perbandingan peningkatan ABG pada bulan ke-3 dan ke-12 pascaoperasi.
* p < 0,01.

Di dalam literatur, ada banyak klasifikasi yang mengevaluasi tentang faktor

prognostik osikuloplasti. Austin telah mengembangkan sebuah sistem yang
mendeskripsikan kondisi osikular pada telinga yang sakit dan menganggap bahwa tidak
adanya maleus sebagai faktor risiko penting untuk osikuloplasti. Dalam klasifikasi yang
dibuat oleh Belluci, osikuloplasti dievaluasi menjadi empat kelompok, sesuai dengan
derajat otorrhea dan malformasi nasofaring. Menurut klasifikasi Belluci, hasil
osikuloplasti pada pasien dengan supurasi persisten dan defek palatum telah dilaporkan
sedikit lebih buruk. Dornhoffer, dalam klasifikasi Belluci, telah melaporkan bahwa tidak
ada perbedaan yang signifikan secara statistik antara hasil osikuloplasti dari kedua
kelompok. Namun, mereka telah melaporkan deteriorasi pada transisi dari grup 1 ke 3.
7
Dornhoffner telah mengungkapkan bahwa kondisi mukosa telinga tengah dapat
mempengaruhi hasil dari osikuloplasti.
Black telah melaporkan bahwa mukosa telinga tengah merupakan faktor
prognostik untuk hasil pendengaran pasca operasi. Klasifikasi SPITE, yang
membedakan faktor prognostik osikuloplasti dari pembedahan, prosthetics, infeksi,
jaringan dan faktor eustachius, telah dikembangkan oleh Black.
Sedangkan Albu dkk. telah melaporkan bahwa hasil otitis media sederhana, otitis
media granulasi, dan otitis media dengan kolesteatoma adalah lebih buruk. Brackmann
dkk. belum melaporkan hasil yang serupa. Yung dkk. telah menyatakan bahwa
keberadaan maleus head adalah faktor terpenting dalam hasil jangka panjang
osikuloplasti.
Sebuah klasifikasi dibuat menurut klasifikasi indeks risiko telinga tengah yang
didefinisikan oleh Kartush dengan mempertimbangkan otorrhea, keadaan osikulus,
adanya perforasi membran timpani, adanya kolesteatoma, status operasi revisi, adanya
efusi telinga tengah dan merokok. Dalam penelitian ini, indeks MERI yang
dikembangkan oleh Kartush digunakan untuk mengevaluasi faktor risiko telinga tengah.
Kami memperkirakan bahwa penilaian ini akan memberikan evaluasi kasus yang lebih
detail dan akurat. Tingkat keberhasilan pasien dengan skor rendah ditemukan lebih
tinggi dibandingkan dengan indeks MERI, sedangkan tingkat keberhasilan lebih rendah
pada kasus dengan skor MERI tinggi. Dalam keberhasilan osikuloplasti, faktor
prognostik yang telah dinilai dengan baik akan berkontribusi pada pencapaian hasil yang
sukses. Oleh karena itu, menurut kami, indeks MERI harus digunakan untuk evaluasi
hasil osikuloplasti.
Tidak ada informasi yang cukup tentang hubungan usia untuk osikuloplasti dalam
literatur. Beberapa penulis menyarankan bahwa usia tertentu harus menunggu
beberapa waktu untuk dapat dilakukan operasi, namun beberapa penulis berpendapat
bahwa timpanoplasti harus dilakukan tanpa penundaan untuk mencegah komplikasi
otitis media kronis. Studi tentang osikuloplasti juga dilaporkan tidak cukup. Dalam
penelitian ini, kasus pediatri dan dewasa yang pernah menjalani osikuloplasti dengan
timpanoplasti dibagi menjadi dua kelompok. Dalam penelitian kami, tingkat destruksi
tulang pendengaran relatif tinggi. Meskipun kami tidak mengetahui alasan pasti dari
kondisi ini pada pasien kami, frekuensi otitis media kronis, infeksi berkepanjangan di
telinga media dan ketidakpatuhan pasien dengan perawatan medis merupakan

8
 penyebab untuk hasil ini. Skor MERI kasus dikalkulasi. Hasil osikuloplasti yang lebih baik
terlihat pada pasien pediatri. Kemungkinan penyebabnya mungkin dikarenakan patologi
seperti plak sklerotik, jaringan granulasi dan pita fibrotik akibat otitis media kronis lebih
sedikit dalam kasus ini. Meskipun hasil osikuloplasti dan tympanoplasti dianggap lebih
buruk pada kasus pediatrik karena anatomi tuba eustachius yang lebih horizontal dan
lebih pendek daripada kasus dewasa dan perawatan pasca operasi lebih menyulitkan,
perpanjangan otitis media kronis, perubahan pada mukosa dan struktur telinga tengah
dapat menyebabkan memburuknya keberhasilan osikuloplasti dan tympanoplasty pada
orang tua. Selain itu, gangguan pendengaran parsial pada kasus pediatrik menyebabkan
penurunan kemampuan berbicara, perkembangan saraf, dan kinerja sekolah. Menunda
osikuloplasti akan menyebabkan penurunan keberhasilan operasi pada kelompok usia
dewasa dan juga pada kondisi yang tidak diinginkan pada kasus anak. Setelah
mempertimbangkan data penelitian ini, hasil osikuloplasti pediatrik lebih baik pada
kelompok usia dewasa. Kami percaya bahwa osikuloplasti tidak boleh ditunda pada
kelompok usia pediatri.

Tabel 5
Perbandingan ABG
Group A Group B
ap ap
Malleus Malleus

Normal (N: Absent (N: 13) Normal (N: Absent (N: 11)
17) 19)
Postoperative 3rd month ABG gain 25.8 + 10.2 24.1 + 8.4 0.0001* 21.4 + 11.8 19.2 + 9.8 0.0001*
(dB)
Postoperative 12th month ABG gain 27.4 + 8.8 22.9 + 8.6 0.0001* 21.2 + 10.2 18.9 + 8.4 0.0001*
(dB)
ap 0.252 0.068 0.426 0.228
ap ap
Stapes Stapes
Normal Defective (N: Normal (N:7) Defective (N:
(N:12) 18) 23)

Postoperative 3rd month ABG gain 22.8 + 9.2 25.8 + 6.6 0.056 20.4 + 13.2 21.6 + 11.2 0.102
(dB)
Postoperative 12th month ABG gain 23.2 + 8.8 26.2 + 9.3 0.062 19.8 + 8.4 22.0 + 8.1 0.068
(dB)
ap 0.116 0.314 0.108 0.606

Singkatan: ABG, Air-Bone Gap. 9

a Paired samples test.
* p < 0.01.
 Pentingnya keberadaan osikulus individual untuk keberhasilan osikuloplasti tetap
menjadi isu kontroversial dalam literatur. Keberadaan malleus memiliki nilai prediktif
dalam keberhasilan osikuloplasti karena posisinya. Beberapa penulis menyatakan
bahwa keberadaan maleus memiliki faktor prognostik yang penting untuk keberhasilan
osikuloplasti. Jika tidak, nilai prognostik keberadaan suprastruktur stapes tetap menjadi
isu kontroversial dalam osikuloplasti. Dalam penelitian ini, kami mengamati bahwa
keberadaan malleus adalah prediktor yang penting untuk keberhasilan ossiculoplasti.
Meskipun penelitian ini memberikan informasi penting, namun studi ini memiliki
beberapa keterbatasan. Jumlah kasus yang relatif rendah dan desain penelitian
retrospektif merupakan salah satu keterbatasan utama. Waktu follow-up yang relatif
lama memberikan hasil studi yang lebih reliabel. Ada persyaratan untuk memvalidasi
data penelitian ini dengan studi prospektif, termasuk jumlah pasien yang lebih banyak.

Kesimpulan
Dalam penelitian ini, pengaruh usia pada hasil osikuloplasti dievaluasi. Hasil
osikuloplasti ditemukan lebih baik pada kelompok usia anak. Kami berpendapat bahwa
osikuloplasti harus dilakukan tanpa penundaan pada kelompok usia anak. Studi
prospektif dengan lebih banyak pasien masih diperlukan.

10