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01

MERI-TRP

Introduction

The Tympanoplasty Reporting Protocol (TRP) can be used to generate a numeric indicator of the severity of middle ear disease. An index of Middle Ear Risk (MER) can be used to stratify patient groups and allow more meaningful comparisons between different studies.

In the first MERI publication of 1994*, Kartush introduced five concepts:

1. TRP: Tympanoplasty reporting protocol – minimum data set for publishing

2. MERI: Middle Ear Risk Index - a numeric indicator for severity of disease which is derived from a small subset of the TRP data

3. AK: Austin-Kartush Ossicular Classification

4. Stratifications to improve study comparisons

a. Risk Categories: Mild, Moderate, Severe
b. Hearing Outcome Categories

Excellent: 0 – 10db
Good: 10 – 20db
Fair: 20 – 30db
Poor: > 30db

In 2001, there was a small update to add smoking as a risk factor and to increase the cholesteatoma risk from 1 to 2.

With this app we are now introducing the latest iteration, MERI Hybrid 2021.

The purpose of this change is twofold.

First, to improve MERI by adopting a number of key factors from the Black SPITE and Dornhoffer OOPS systems that were absent from the MERI.

-Surgical intervention
-More precise delineation of diseased middle granulation tissue vs effusion / otorrhea

The second addition includes fields for more precise description of cholesteatoma. While there is no consensus, two systems have risen to international prominence. Rather than choose one arbitrarily, we include fields for both the EAONO/JOS as well as the ChOLE classification systems. See full references cited below.

MERI 2001 vs 2021 Hybrid Update

02

MERI-TRP

MERI Scores

MERI 2001 Risk Categories:

Normal = 0
Mild pathology = 1-3
Moderate pathology = 4-6
Severe pathology => 7

MERI Hybrid 2021 Risk Categories:

Normal = 0
Mild pathology = 1-3
Moderate pathology = 4-8
Severe pathology => 9

03

MERI-TRP

MERI Table

MERI 2001;

Otorrhea (Belluci):
Dry = 0;
Occasionally wet = 1;
Persistently wet = 2;
Wet, cleft palate = 3

Perforation:
None = 0; Present = 1

Cholesteatoma:
None = 0; Present = 2

Ossicular Status:
0) M+I+S+ = 0;
A) M+S+ = 1;
B) M+S- = 2;
C) M-S+ = 3;
D) M-S- = 4;
E) Ossicular head fixation = 2;
F)Stapes fixation = 3

Middle ear granulation or effusion:
No = 0; Yes = 2

Previous surgery:
None = 0; Staged = 1; Revision = 2

Smoker:
No = 0; Yes = 2

MERI Hybrid 2021;

Otorrhea (Belluci):
Dry = 0;
Occasionally wet = 1;
Persistently wet = 2;
Wet, cleft palate = 3

Perforation:
None = 0; Present = 1

Cholesteatoma:
None = 0; Present = 2

Ossicular Status:
0) M+I+S+ = 0;
A) M+S+ = 1;
B) M+S- = 2;
C) M-S+ = 3;
D) M-S- = 4;
E) Ossicular head fixation = 2;
F)Stapes fixation = 3

Middle ear granulation:
No = 0; Yes = 2

Middle ear fluid:
No = 0; Yes = 1

Previous surgery:
None = 0; Staged = 1; Revision = 2

Smoker:
No = 0; Yes = 2

Surgical interventions:
Tympanoplasty wo Mastoidectomy = 1; CWU = 2; CWD = 3

M malleus, I incus, S stapes, CWU Canal wall up, CWD Canal wall down.

04

MERI-TRP

Austin-Kartush Ossicular Classification

Class 0
Normal Ossicles
M+I+S+

Class A
Absent Incus
M+S+

Class B
Absent Incus and Stapes
M+S-

Class C
Absent Malleus and Incus
M-S+

Class D
Absent Ossicles
M-S-

Class E
Ossicular Head Fixation

Class F
Stapes Fixation
[F1-Superstructure intact, F2-Superstructure absent]

Key Articles

*Kartush JM. Ossicular chain reconstruction capitulum to malleus. Otolaryngol Clin North Am. 1994.27:689-715.

Introduced five concepts:
1. TRP: Tympanoplasty reporting protocol – minimum data set for publishing
2. MERI: Middle Ear Risk Index - a numeric indicator for severity of disease
3. AK: Austin-Kartush Ossicular Classification
4. Stratifications to improve study comparisons
a. Risk Categories” Mild, Moderate, Severe
b. Hearing Outcome Categories

Becvarovski Z, Kartush JM. Smoking and tympanoplasty: implications for prognosis and the middle ear risk index (MERI). Laryngoscope. 2001.111:1806-11. (Updated the 1994 MERI)

Kartush J, Michaelides E, Becvarovski Z, LaRouere M: Over-Under Tympanoplasty: Laryngoscope 2002;112:802-807

Bellucci RJ. Selection of cases and classification of tympanoplasty. Otolaryngol Clin North m. 1989 Oct;22(5):911–26

Austin DF. Reporting results in tympanoplasty. Am J Otol. 1985 Jan;6(1):85–8.

AJudd, Ryan T.; Imbery, Terence E.; Gluth, Michael B. The Utility of Numeric Grading Scales of Middle Ear Risk in Predicting Ossiculoplasty Hearing Outcomes, Otology & Neurotology: December 2020 - Volume 41 - Issue 10 - p 1369-1378

The present study found a much weaker correlation between OOPS and hearing outcomes, and this may be a product of one key limitation to both OOPS and SPITE—namely, they are both derived from statistical analysis of the outcomes of single surgeons. (MERI is not directly based on statistical analysis of outcomes at all.)

SPITE Articles

Black B. Ossiculoplasty prognosis: the spite method of assessment. Am J Otol. 1992 Nov;13(6):544–51.

Black, Bruce Reporting Results in Ossiculoplasty, Otology & Neurotology: July 2003 - Volume 24 - Issue 4 - p 534-542

Judd, Ryan T.; Imbery, Terence E.; Gluth, Michael B. The Utility of Numeric Grading Scales of Middle Ear Risk in Predicting Ossiculoplasty Hearing Outcomes, Otology & Neurotology: December 2020 - Volume 41 - Issue 10 - p 1369-1378

SPITE originally had 19 data fields. Judd selected only 12 of these to study. “…the SPITE method is the most complicated to apply and also has some ambiguous grading elements as alluded to in the methods section.”

OOPS Articles

Dornhoffer JL, Gardner E. Prognostic factors in ossiculoplasty: a statistical staging system. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol. 2001 May;22(3):299–304.

Gluth MB, Moore PC, Dornhoffer JL. Method and Reproducibility of a Standardized Ossiculoplasty Technique. Otol Neurotol. 2012 Sep;33(7):1207–1212.

Page, Joshua Cody; Cox, Matthew D.; King, DeAnne; Allsopp, Tristan; Dornhoffer, John L. Long-term Outcomes of Ossiculoplasty With and Without an Intact Malleus, Otology; Neurotology: January 2019 - Volume 40 - Issue 1 - p 73-78

This article said malleus did not seem significant so OOPS needs to be revised” “The data also call into question the prognostic strength of the OOPS Index with our method of reconstruction. We are in the process of analyzing and modifying the OOPS Index in light of this data set.” “We believe the currently reported disparity present in this study arises from an evolution of technique.

Kotzias SA, Seerig MM, Mello MF, Chueiri L, Jacques J, Silva MB, et al. Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors. Braz J Otorhinolaryngol. 2020;86:49–55.

Compared MERI vs OOPS
“The OOPS index seems not to be accurate on prognosticating hearing outcomes, while the MERI index can be a valuable tool for surgeons to estimate the risks, predict success of the surgery as well as to select the best candidates for reconstruction.”

Ryan T.; Imbery, Terence E.; Gluth, Michael B. The Utility of Numeric Grading Scales of Middle Ear Risk in Predicting Ossiculoplasty Hearing Outcomes, Otology & Neurotology: December 2020 - Volume 41 - Issue 10 - p 1369-1378

MERI Articles

Pasha R, Hill SL, Burgio DL. Evaluation of Hydroxyapatite Ossicular Chain Prostheses. Otolaryngol Neck Surg. 2000 Oct 1;123(4):425–9.

Prognostic risk factors graded by the Middle Ear Risk Index indi- cate a tendency for worse postoperative hearing with increasing Middle Ear Risk Index.

Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngology-Head and Neck Surgery. 2008.139:386-98.

A high MERI had a much higher possibility of CWD surgery and lower chance of successful tympanoplasty. The consideration of the high MERI allows the surgeon to counsel the patient more accurately before surgery and provide realistic expectations. This will enable the surgeon to design a case-specific operation strategy for each patient.

Chrobok V, Pellant A, Meloun M, Pokorny K, Simáková E, Mandysová P. Prognostic Factors for Hearing Preservation in Surgery of Chronic Otitis Media. Int Adv Otol. 2009.5(3):310-17.

The presented evaluations of the hearing threshold before and after surgery in patients with chronic otitis media demonstrate that highly significant negative pre-op prognostic factors include the presence of cholesteatoma, perforation of the eardrum, ossicular status, previous surgery, and the MERI risk value.

Richard J. Wiet, R. Mark Wiet, Experience-driven ossiculoplasty, Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 21, Issue 3, 2010, Pages 211-216

Sharma A, Saxena RK, Verma LR, Bhandari S. Correlation Between MERI and Hearing After Tympanoplasty. J Nepalgunj Med Coll. 2015;13(2):6–9.

Prospective study: MERI scoring is useful for predicating the outcome of hearing after tympanoplasty.

Ahmed A, Sharma SC. Middle Ear Risk Index [MERI] as Prognostic Factor in Tympanomastoidectomy with Tympanoplasty. Madridge J Otorhinolaryngol. 2016 May 17;1(1):15–22.

The Middle ear risk index was also found to be significant predictor of the outcome of surgery. The patients with mild MERI scores had significantly better prognosis than the patients with severe MERI scores.

Felek SA, Celik H, Islam A, Elhan AH, Demirci M, Samim E. Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index. Am J Otolaryngol. 2010 Oct;31(5):325–31.

The middle ear risk index is a valuable tool for the surgeon to judge the risks and the probability success of the procedure as well as to make a good patient selection.

Kumar N, Madkikar NN, Kishue S, Chilke D, J Kiran, Shinde. Using middle ear risk index and ET function as parameters for predicting the outcome of tympanoplasty. Indian journal of otolaryngology and head & neck surgery. 2012. 64(1):13-16.

Hence from the present study it can be confidently concluded that MERI scoring can be useful in predicting the outcome of tympanoplasty.

Emir H, Kaptan ZK, Göcmen H, et al. Ossiculoplasty with intact stapes: analysis of hearing results according to the middle ear risk index. Acta Otolaryngol (Stockh). 2009 Jan 1;129(10):1088–94.

Demir UL, Karaca S, Ozmen OA, Kasapoglu F, Coskun HH, Basut O. Is it the Middle Ear Disease or the Reconstruction Material That Determines the Functional Outcome in Ossicular Chain Reconstruction? Otol Neurotol. 2012 Jun;33(4):580.

“We conclude that the MERI score is an important determinant for the success of ossiculoplasty.” “We conclude that the success of ossiculoplasty is highly correlated with the pathophysiological status of the middle ear and is independent of the type of replacement material”

Callioglu, Elif Ersoy et al. “Cartilage Graft or Fascia in Tympanoplasty in Patients with Low Middle Ear Risk Index (anatomical and Audological Results).” European archives of oto-rhino-laryngology. 270.11 (2013): 2833–2837.

Abshirini H, Saki N, Nikakhlagh S, Yavari M. Evaluation of Prognostic Factors in Tympanoplasty. Biosci Biotech Res Asia 2015;12(spl.edn.1)

Patients with low MERI score (< 3) had significantly higher rates of success.

Kalyanasundaram R, Narendra G. Corelation between middle ear risk index (MERI) and tympanoplasty- a prospective study. Panacea Journal of Medical Sciences. 2017.7(2):65-67.

Patients with a high MERI score had low graft uptake. This study shows that MERI score is a prognostic indicator of tympanoplasty results. It is inversely proportional to graft uptake.

Kotzias SA, Seerig MM, Mello MFPC de, et al. Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors. Braz J Otorhinolaryngol. 2018 Oct 18.

“The OOPS index seems not to be accurate on prognosticating hearing outcomes, while the MERI index can be a valuable tool for surgeons to estimate the risks, predict success of the surgery as well as to select the best candidates for reconstruction.”

Hayati R, Hajarharyuna TS. Middle Ear Risk Index Scores as a Predictor for Hearing Threshold after Tympanoplasty in Patients with Chronic Suppurative Otitis Media. J Clin Diagn Res. 2018 Apr 12(4): MC01-MC03.

“There was a significant negative correlation between MERI Scores as the predictor of hearing threshold which indicated that the lower the MERI Scores were, the better the improvement of hearing threshold. MERI Scores could be used as a measuring instrument to assess the prognosis of hearing threshold after tympanoplasty.”

Kaplankiran H, Ceylan ME, Yildirim GA, Ceylan G, Dalğiç A, Olgun L. Audiological Results of Total Ossicular Replacement Prosthesis with Cartilage Shoe Technique. Turk Arch Otorhinolaryngol. 2018 Jun;56(2):95–101.

MERI values were used to create two prospective, stratified groups for comparison of OCR with and without a cartilage shoe for titanium TORP stabilization. The shoe was found to be especially effective in higher risk groups.

Ramya R. Middle ear risk index (MERI) as a prognostic factor in endoscopic tympanoplasty in chronic otitis media (COM). Presented as a Dissertation at Stanley Medical College, Chennai; 2018.

Patel R, Ghai SK, Kulkarni SV, Bharadwaj C, Sancheti V, Burse KS. Prospective Study of Audiological Analysis of Ossiculoplasty in Cases of Chronic Suppurative Otitis Media. MVP J Med Sci. 2019 May 22;6(1):45-52–52.

Rakesh Saboo, Amit Modwal, Priyanjal Gautam. Tubotympanic CSOM: clinical profile of perforation, eustachian tube function and MERI score as parameter for outcome of tympanoplasty. Transworld Medical Journal. 2(2):154¬159.

The results achieved by use of appropriate MERI score and assessing status of eustachian tube functioning were good.

Ohki, Masafumi, Shigeru Kikuchi, and Sunao Tanaka. “Endoscopic Type 1 Tympanoplasty in Chronic Otitis Media: Comparative Study with a Postauricular Microscopic Approach.” Otolaryngology–Head and Neck Surgery 161.2 (2019): 315–323.

De Vos et al and Yung and Vowler statistically demonstrated the importance of the malleus handle, mucosa status, and otorrhea, which is a factor of the MER index.

Calim OF, Veri̇m A, Özkul MH, et al. An evaluation of prognostic factors for tympanoplasty with titanium prostheses in chronic ear surgery. Anadolu Klin Tip Bilim Derg. 2019 Jan 30;24(1):8–14.

We found that presence of the malleus and stapes suprastructure and prognostic MERI grading affected the reconstruction success rate. The air-bone gap results were found to be 100%, 87.5% and 12.5% in the mild, moderate, and severe MERI groups, respectively. MERI scoring might help surgeons develop a patient-specific operation strategy by providing guidance during ossiculoplasty.

Sarfaraz, Tabassum A. An observational study on tympanoplasty in terms of middle ear risk index (MERI) of patients with chronic suppurative otitis media. International Journal of Medical and Health Research. 2017.3(6):25-28.

Patients with mild MERI Score were higher rate of succeeded for tympanoplasty than patients with moderate and severe MERI Score.

Sridhar R. Impact of otorrhoea and ossicular status on the effect of tympanoplasty. Int J Otorhinolaryngol Head Neck Surg 2018;4(6):1366-1371

MERI scoring was considered to be very important scoring system which helps in assessing and analyzing the patient pre- operatively and intra operatively that helps in predicting the outcome of surgery.

Sonawale S et al: Study of type II Tympanoplasty using Autologous incus. Indian Journal of Basic and Applied Medical Research – Otorhinolaryngology Special Issue, June 2018, 7 (3), 31-41

Cebeci S, Özbilen MS, Bayramoğlu I, Kemaloğlu YK, Uygur KK, Bayazit YA, Karamert R. Impact of the demographic and aetiological factors and intraoperative findings on postoperative outcomes in chronic otitis media surgery. Turk J Med Sci. 2020 Feb 13;50(1):155-162.

MERI is a useful tool for the evaluation of the severity of middle ear disease and predicts the surgical success. In this study, it can be seen that the anatomic and functional success decreases as MERI scores increase. Moreover, the results showed that MERI scores were related to the type of operation. The highest MERI scores were seen in patients who underwent modified radical mastoidectomy, and the lowest MERI scores were in patients who underwent simple tympanoplasty

Vignadutt, P.; Shaik, Ali. A retrospective study on middle ear risk indices in analysing the postoperative outcome following tympanoplasty. International Journal of Otorhinolaryngology and Head and Neck Surgery, [S.l.], v. 5, n. 5, p. 1234-1239, Aug. 2019. ISSN 2454-5937.

MERI index is in fact a very useful and honest predictor of the graft uptake and audiological gain in patients undergoing tympanoplasty surgeries for CSOM. Lower the MERI index better the outcome. Positive Belluci criteria were also found to be inversely associated with the graft uptake.

Shishegar, M., Faramarzi, M. & Rashidi Ravari, M. Evaluation of middle ear risk index in patients undergoing tympanoplasty. Eur Arch Otorhinolaryngol 276, 2769–2774 (2019).

MERI score is a useful tool for predicting the success rate of tympanoplasty and helps the surgeon planning the type of tympanoplasty.

Nallapaneni, L.S., Sudarsan, S. & Krishnamoorthy, S. A Prospective Study on Middle Ear Risk Index (MERI) and Outcome of Tympanoplasty with a Note on quality-of-Life (QOL). Indian J Otolaryngol Head Neck Surg (2020)

MERI score is a prognostic tool to predict the outcome of tympanoplasty. It has an inverse relation with graft uptake and hearing benefit. Based on MERI score, the chances for surgical success and hearing benefit could be explained to the patient to give them realistic expectations.

Anil S. Harugop, Somashekhar Abhilasha, Pratibha S. Desai. Assessment of middle ear risk index in predicting the outcome of treatment of CSOM. Int J Otorhinolaryngol Head Neck Surg. 2020 Nov;6(11):2075-2080

The outcome of surgery in the patients who undergo surgical treatment for CSOM can be predicted well using MERI.

Poonam K. Saidha, Sahil Kapoor, Arpita Suri, Vikas Kakkar: Evaluation of the role of middle ear risk index as a prognostic tool in cases of tympanoplasty in chronic suppurative otitis media. March 2021 International Journal of Otorhinolaryngology and Head and Neck Surgery 7(4):622

Higher the MERI score, lower was the graft uptake while lower the MERI score, higher was the graft uptake. Hence, MERI is a useful tool to ascertain the prognosis of tympanoplasty.

de la Torre Carlos, Vasquez Carolina, Villamor Perla: Middle Ear Risk Index (MERI) As A Prognostic Factor For Tympanoplasty Success In Children. February 2021. International Journal of Pediatric Otorhinolaryngology

Presurgical MERI in children may be a useful tool to determine if patients are candidates for tympanoplasty, more aggressive interventions, or if medical treatment before tympanoplasty is necessary to improve prognosis. When facing a high MERI score, parents and family should be advised before surgery about the possibility of tympanoplasty failure.

Zhu X-H, Zhang Y-L, Xue R-Y, Xie M-Y, Tang Q, Yang H. Predictors of anatomical and functional outcomes following tympanoplasty: A retrospective study of 413 procedures. Laryngoscope Investigative Otolaryngology. 2021;1-8.

MERI score greater than three was found to be a significant predictor of postoperative hearing and could serve as a useful tool for assisting clinicians in perioperative risk assessment.
Previous studies have reported smoking to be of prognostic importance, and it was added in MERI 2001.11 In our study, smoking was a predictor for the hearing outcome following tympanoplasty. The rate of hearing failure was two times higher
Moreover, the obstructed aditus ad antrum and MERI >3 (P < .001) were independent predictors of hearing failures

Austin-Kartush Articles

Moretz WH. Ossiculoplasty With an Intact Stapes: Superstructure Versus Footplate Prosthesis Placement. Laryngoscope, 108 (Suppl.89):1-12,1998

Maceri D. Stabilization of Total Ossicular Replacement Prosthesis in Ossiculoplasty. Laryngoscope 109: 1884-5, November 1999

Vincent, Robert; Oates, John; Sperling, Neil M.; Annamalai, Sivakumar Malleus Relocation in Ossicular Reconstruction: Managing the Anteriorly Positioned Malleus: Results in a Series of 268 Cases, Otology & Neurotology: May 2004 - Volume 25 - Issue 3 - p 223-230

Vincent, Robert; Sperling, Neil M; Oates, John; Osborne, Jonathan. Ossiculoplasty with Intact Stapes and Absent Malleus: The Silastic Banding Technique, Otology & Neurotology: September 2005 - Volume 26 - Issue 5 - p 846-852

Martin, T.P.C., Weller, M.D., Kim, D.S. & Smith, M.C.F.. Results of primary ossiculoplasty in ears with an intact stapes superstructure and malleus handle: inflammation in the middle ear at the time of surgery does not affect hearing outcomes. Clin. Otolaryngol. 2009, 34, 218–224

Iurato, Salvatore; Marioni, Gino; Onofri, Marina Hearing Results of Ossiculoplasty in Austin-Kartush Group A Patients, Otology & Neurotology: March 2001 - Volume 22 - Issue 2 - p 140-144

Richard J. Wiet, R. Mark Wiet, Experience-driven ossiculoplasty, Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 21, Issue 3, 2010, Pages 211-216.

Vincent, Robert; Rovers, Maroeska; Mistry, Nina; Oates, John; Sperling, Neil; Grolman, Wilko. Ossiculoplasty in Intact Stapes and Malleus Patients: A Comparison of PORPs Versus TORPs With Malleus Relocation and Silastic Banding Techniques. Otology & Neurotology. 32(4):616-625, June 2011.

Sue Jean Mun, Joo Hyun Park, Chang Myeon Song: Audiologic Results of Ossiculoplasty Using Malleus Footplate Assembly: The Comparison between Autologous Incus and Hydroxyapatite. Korean J Audiol 2011;15:141-146

Vincent, Robert; Bittermann, Arnold J. N.; Wenzel, Gentiana; Oates, John; Sperling, Neil; Lenarz, Thomas; Grolman, Wilko Ossiculoplasty in Missing Malleus and Stapes Patients: Experimental and Preliminary Clinical Results With a New Malleus Replacement Prosthesis With the Otology-Neurotology Database, Otology & Neurotology: January 2013 - Volume 34 - Issue 1 - p 83-90

Nadir Yıldırım, Semra Külekçi, Zühal Zeybek Sivas, Cüneyt Kucur. Comparison of Primary and Secondary Cholesteatomas in Terms of Ossicular Destruction and Complications. Turk Arch Otolaryngol 2014; 52: 121-5

Ucar S, Iseri M, Ozturk M. Evaluation of functional results of CWD surgery with ossicular replacement prosthesis due to cholesteatoma using computed tomography. Eur Arch Otorhinolaryngol. 2014;271(9):2393–2400.

Blom EF, Gunning MN, Kleinrensink NJ, et al. Influence of Ossicular Chain Damage on Hearing After Chronic Otitis Media and Cholesteatoma Surgery: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2015;141(11):974–982.

A systematic meta-analysis of publications from PubMed, EMBASE, and Cochrane Library databases over 40 years:
“For future studies, we recommend the use of the Austin-Kartush criteria to measure ossicular chain damage OCD and the AAO-HNS guidelines in audiology for reporting hearing outcomes at standardized intervals to maximize comparability of results.”
“Pooled results of Austin-Kartush studies showed that in patients with COM, with or without cholesteatoma, the malleus status is a significant predictor of postoperative hearing outcome, independent of the stapes condition”

Gerard, Jean-Marc; DeBie, Gersende; Franceschi, Daniel; Deggouj, Naima ;Gersdorff, Michel . Ossiculoplasty with hydroxyapatite bone cement: our reconstruction philosophy. European Archives of Oto-Rhino-Laryngology" - Vol. 272, no. 7, p. 1629-1635 (2015)

Deniz Tuna Edizer, MD, Yusuf Muhammed Durna, MD, Bahtiyar Hamit, MD, Hasan Demirhan, MD, and Ozgur Yigit, MD. Malleus to Stapes Bone Cement Rebridging Ossiculoplasty: Why Don’t We Perform Frequently? Annals of Otology, Rhinology & Laryngology 2015 125:6, 445-451

Jean‐Marc Gérard, Gersende De Bie, Daniel Franceschi · Naima Deggouj · Michel Gersdorff. Ossiculoplasty with hydroxyapatite bone cement: our reconstruction philosophy. Eur Arch Otorhinolaryngol (2015) 272:1629–1635

Mustafa Aslıer, Taner Kemal Erdag, Sulen Sarioglu, Enis Alpin Güneri, Ahmet Omer Ikiz, Evren Uzun, Erdener Özer. Analysis of histopathological aspects and bone destruction characteristics in acquired middle ear cholesteatoma of pediatric and adult patients. International Journal of Pediatric Otorhinolaryngology, Volume 82, 2016, Pages 73-77, ISSN 0165-5876

Thamizh Arasan. New Classification of Ossicular Status and Study In Patients with Ossicular Erosion to be Used for Ossiculoplasty.Otolaryngology Online Journal (2017) Volume 7, Issue 1, 144

Jerome Nevoux, Gilles Roger, Pierre Chauvin; Francoise Denoyelle; Erea Noel Garabedian. Cartilage Shield Tympanoplasty in Children. Arch Otolaryngol Head Neck Surg. 2011;137(1):24-29

Sue Jean Mun, Joo Hyun Park, Chang Myeon Song: Audiologic Results of Ossiculoplasty Using Malleus Footplate Assembly: The Comparison between Autologous Incus and Hydroxyapatite. Korean J Audiol 2011;15:141-146

Gupta A, Kumar A, Tuli IP, Soni P. Comparative evaluation of early results with ossicular reconstruction employing titanium and hydroxyapatite prostheses. Astrocyte 2015;2:111-5

Scott-Brown's Otorhinolaryngology and Head and Neck Surgery Volume 2: Paediatrics, The Ear, and Skull Base Surgery By Ray W Clarke. 2018

Mhashal SK et al. Assessment of short term hearing improvement in patients of cartilage interposition ossiculoplasty for lenticular process of incus necrosis in cases of chronic suppurative otitis media: mucosal disease. International J Otorhinolaryngol Head Neck Surgery | October-December 2017 | Vol 3 | Issue 4

Irwan et al. Pre and intraoperative findings of chronic otitis media. 2019 J. Phys.: Conf. Ser. 1246 012019

Nivee N, Varghese BS. Post-operative Auditory Gain in Patients Undergoing Intact Canal Wall Mastoidectomy and Ossiculoplasty with Primary Malleus Transposition (rotation) Ossiculoplasty. Int J Sci Stud 2019;6(12):53-56

Düzenli, U., & Kıroğlu, A. Manubrio-incudo-stapedioplasty for reconstruction of Austin–Kartush type B ossicular defects. The Journal of Laryngology & Otology, (2019). 133(6), 457-461.

Arindam Das, MS; Sandipta Mitra, MS ; Debasish Ghosh, MS; Arunabha Sengupta. Endoscopic Ossiculoplasty: Is There Any Edge Over the Microscopic Technique?. Laryngoscope, 130:797–802, 2020

MERI & Austin-Kartush Reviews Articles

Balough B, Kartush J: Ossicular chain reconstruction – Current Opinion in otolaryngology, Vol 9, Issue 5, 2001:272-278.

Kartush J, Babu S : Ossicular chain reconstruction – pitfalls. Wiet R (ed) Ear and Temporal Bone Surgery: Minimizing Risks and Complications. Thieme, New York, 2006:90-101.

Kartush J: Ossicular chain reconstruction. Master Techniques in Otolaryngology – Head and Neck Surgery: Otology, Neurotology and Lateral Skull Base Surgery, edited by J. Thomas Roland, Jr., MD; series editor Eugene Myers, MD. Wolters Kluwer, Philadelphia. P109 – 124, 2018.

Neudert M, Zahnert T. Tympanoplasty – news and new perspectives. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2017;16: Doc 07.

Susen Lailach, Thomas Zahnert, Marcus Neudert. Data and Reporting Quality in Tympanoplasty and Ossiculoplasty Studies. Otolaryngology–Head and Neck Surgery 2017, Vol. 157(2) 281–288

Over a decade, not a single publication fulfilled all AAO criteria
However, while a great number of parameters could be recorded, a publication should focus particularly on factors that contribute to quality assurance and assessment. Although the surgical, prosthetic, infection, tissue, and eustachian (SPITE) criteria introduced by Black report in great detail on nearly all influencing factors, this 19-item questionnaire seems to be cumbersome in a single study, which may primarily focus on the analysis of a special reconstruction technique.

Adva Buzi, Michael B. Gluth, and Bruce Black. Chronic Ear Disease in the Modern Era: Evolution of Treatment, Epidemiology, and Classification. In Book: The Chronic Ear. Dornhoffer, J.L., & Gluth, M.B. Thieme (2016).

Although SPITE criteria introduced by Black report in great detail on nearly all influencing factors, this 19-item questionnaire seems to be cumbersome in a single study, which may primarily focus on the analysis of a special reconstruction technique.

Marcus Neudert: Quality in middle ear surgery – a critical position determination. Qualität in der Mittelohrchirurgie – eine kritische Standortbestimmung. Laryngo-Rhino-Otol 2020; 99(S 01): S1-S26

Linder, Thomas E.; Shah, Shankar; Martha, Aline Silveira; Röösli, Christof; Emmett, Susan D. Introducing the “ChOLE” Classification and Its Comparison to the EAONO/JOS Consensus Classification for Cholesteatoma Staging, Otology & Neurotology: January 2019 - Volume 40 - Issue 1 - p 63-72

AK classification is part of the “ChOLE” Classification.

Judd, Ryan T.; Imbery, Terence E.; Gluth, Michael B. The Utility of Numeric Grading Scales of Middle Ear Risk in Predicting Ossiculoplasty Hearing Outcomes, Otology & Neurotology: December 2020 - Volume 41 - Issue 10 - p 1369-1378

See comments in above iterations.

Cholesteatoma Classifications Articles

Yung, Matthew et al. “EAONO/JOS Joint Consensus Statements on the Definitions, Classification and Staging of Middle Ear Cholesteatoma.” The journal of international advanced otology. 13.1 (2017): 1–8.

Ardıç FN, Mengi E, Tümkaya F, Kara CO, Bir F. Correlation between Surgical Outcome and Stage of Acquired Middle Ear Cholesteatoma: Revalidation of the EAONO/JOS Staging System. J Int Adv Otol. 2020 Apr;16(1):34-39.

JLinder TE, Shah S, Martha AS, Röösli C, Emmett SD. Introducing the "ChOLE" Classification and Its Comparison to the EAONO/JOS Consensus Classification for Cholesteatoma Staging. Otol Neurotol. 2019 Jan;40(1):63-72.

Bächinger, D., Rrahmani, A., Weiss, N.M. et al. Evaluating hearing outcome, recidivism and complications in cholesteatoma surgery using the ChOLE classification system. Eur Arch Otorhinolaryngol 278, 1365–1371 (2021)

Interestingly, this paper showed that hearing outcomes were best predicted by their modified AK ossicular classification and the presence of complications. “No association between the ChOLE stage was found to both cholesteatoma recidivism and surgical complications.”

Eggink, Maura C.; de Wolf, Maarten J.F.; Ebbens, Fenna A.; Dikkers, Frederik G.; van Spronsen, Erik Evaluation of Long-term Cholesteatoma Recidivism, Otology & Neurotology: April 23, 2021 - Volume Publish Ahead of Print

Unlike the other Cholesteatoma reviews, this independent evaluation showed poor correlation of both EAONO and ChOLE systems and suggested neither be used at this time.