Outcomes of type III tympanoplasty: our experience


  • Ravishankar Chandrashekhar Department of Otorhinolsryngology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
  • Ramya Bandadka Department of Otorhinolsryngology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India




Type III tympanoplasty, Autologous incus, Teflon prosthesis


Background: Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement and healing of cavity in patients who underwent type III tympanoplasty.

Methods: A retrospective chart review of 21 patients who underwent type III tympanoplasty at Bowring and Lady Curzon Hospital from January 2018 to December 2018 was done. In 7 patients autologous incus, 6 tragal cartilage and 8 teflon prosthesis was used for ossiculoplasty. Intra and postoperative events were assessed. Pure tone audiograms done after 3 and 6 months were compared.  

Results: 15 patients who underwent canal wall down procedure (CWDP) had a mean hearing gain of 20.33 dB and 26.67 dB while in 5 patients of canal wall up procedure (CWUP) group mean hearing gain was 22.5 dB and 27.5 dB at 3 and 6 months after surgery respectively. Hearing gain was similar in both groups irrespective of the prosthesis used. Autologous materials were used in most of the CWUP with intact stapes and teflon prosthesis was used in majority of CWDP where only mobile stapes foot plate was present. Prosthesis extrusion was not encountered in any of our cases so far in this series.

Conclusions: The post-operative hearing gain with autologous incus, tragal cartilage and teflon middle ear prosthesis are similar. Teflon prosthesis is an effective material for ossiculoplasty, especially useful when incus and stapes are absent while autologous incus or tragal cartilage are preferred in cases with intact stapes head.


Mudhol RS, Naragund AI, Shruthi VS. Ossiculoplasty: Revisited. Indian J Otolaryngol Head Neck Surg. 2013;65(3):451-4.

Bihani A, Jyoti D. Use of incus as an interposition graft in ossiculoplasty for type IIb tympanoplasty. Int J Clin Trial. 2015;2(2):43-6.

O’Reilly RC, Cass SP, Hirsch BE, Kamerer DB, Bernat RA, Poznanovic SP. Ossiculoplasty using incus interposition: Hearing results and analysis of the middle ear risk index. Otol Neurotol. 2005;26:853‑8.

Athanasiadis-Sismanis A, Poe DS. Ossicular chain reconstruction. In: Gulya AJ, Minor LB, Poe DS, eds. Glasscock-Shambaugh Surgery of the ear. 6th ed. Ch. 29. USA: People’s Medical Publishing House; 2010: 489-500.

Mahanty S, Maiti AB, Naskar S, Das SK, Mandal S, Karmakar M. A comparative study of outcome of ossiculoplasty using cartilage graft, bone and different alloplasts in chronic otitis media. Indian J Otol. 2015;21:144-8.

Naragund AI, Mudhol RS, Harugop AS, Patil PH. Ossiculoplasty with autologous incus versus titanium prosthesis: A comparison of anatomical and functional results. Indian J Otol. 2011;17:75-9.

Mardassi A, Deveze A, Sanjuan M, Mancini J, Parikh B, Elbedeiwy A, et al. Titanium ossicular chain replacement prostheses: prognostic factors and preliminary functional results. Euro Annals of Otorhinolaryngol Head Neck Dis. 2011;128:53-8.

Kartush JM. Ossicular chain reconstruction. Capitulum to malleus. Otolaryngol Clin North Am. 1994;27:689‑715.

Thamizharasan P, Ravi K. Comparative study of autologous ossicular graft versus titanium prosthesis (torp and porp) in ossiculoplasty. Bengal J Otolaryngol Head Neck Surg. 2017;25(1):1-7.

Zeitler DM, Lalwani A. Are postoperative hearing results better with titanium ossicular reconstruction prostheses?. Laryngoscope. 2010;120(1):2-3.

Cox MD, Russell JS, Dornhoffer JL. TORP ossiculoplasty outcomes with and without a stapes footplate prosthesis. Otolaryngol Head Neck Surg. 2015;152(3):501-5.

Faramarzi M, Jahangiri R,RoostaS. Comparison of titanium vs. polycel total ossicular replacement prosthesis. Iran J Otorhinolaryngol. 2016;28(85):89-97.

Sayal A, Taneja V, Gulati A. Preliminary hearing results of tympanomastoidectomies using titanium prostheses: scenario in a developing country. Int J Otolaryngol Head Neck Surg. 2013;2(5):195-200.






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