Autograft ossiculoplasty in cholesteatoma surgery: is it feasible?

OBJECTIVE: To investigate whether autologous ossicles can be safely used in ossicular reconstruction in cholesteatoma surgery after attempting cholesteatoma removal under the operating microscope.

STUDY DESIGN: A prospective fine-section histological study of formalin-stored ossicles, harvested from cholesteatomatous ears, to evaluate for existence of residual cholesteatoma after surface disease clearance under the operating microscope.

METHODS: One hundred four ossicles were harvested from 76 patients with cholesteatoma for the study. These malleus heads and includes were categorized into three groups: group 1, ossicles with retained shape and useful bulk, treated by microscopic stripping alone; group 2, ossicles with retained shape and useful bulk, treated by microscopic stripping and drilling; and group 3, badly eroded ossicles, treated by microscopic stripping alone. These treated ossicles were then subjected to 4 microm histopathological study.

RESULTS: Residual disease was identified in 6 of the 104 ossicles. Residual disease was found only in badly eroded ossicles that are not suitable for reconstruction. All the usable ossicles were free of disease.

CONCLUSIONS: Autologous ossicles that have retained body and bulk are safe to use for reconstruction after surface stripping under the operating microscope. Additional burring probably adds a further margin of safety.