After eradication of cholesteatoma, a dry ear has an intact mobile tympanic graft, absent malleus and stapes superstructure, a mobile stapes footplate, an aerated middle ear and a 35 dB conductive gap. Which reconstruction is anatomically appropriate?
With no stapes superstructure and a mobile footplate, a total prosthesis couples the reconstructed drum to the footplate; stability, cartilage protection and ventilation determine outcome.
A. A partial ossicular replacement prosthesis seated on the footplate: A PORP requires an intact stapes superstructure; seating it directly on the footplate is mechanically inappropriate.
B. Malleovestibulopexy with a piston through the footplate: Opening a mobile footplate introduces inner-ear risk and is not indicated for post-cholesteatoma ossicular discontinuity.
C. Revision tympanoplasty without ossicular reconstruction: The graft is intact and mobile; this would not bridge the demonstrated conductive defect.
D. Bone-conduction implantation without discussing ossiculoplasty: Bone-conduction rehabilitation is an alternative, but favourable middle-ear conditions and a mobile footplate make TORP reconstruction a reasonable anatomical choice.
E. A total ossicular replacement prosthesis from tympanic membrane graft to the mobile stapes footplate: With no stapes superstructure and a mobile footplate, a total prosthesis couples the reconstructed drum to the footplate; stability, cartilage protection and ventilation determine outcome.
If the footplate were fixed or the middle ear repeatedly retracted and poorly aerated, prosthetic reconstruction would be less favourable and bone-conduction options should be discussed.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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