{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:24:00Z","timestamp":1792369440790,"version":"4.4.0"},"reference-count":68,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine which ear environment risk factors impact ossiculoplasty hearing outcomes and to generate a statistically\u2010valid grading system for ossiculoplasty outcome reporting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Type<\/jats:title><jats:p>Retrospective case series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multi\u2010institutional database was generated from cases performed between 2011 and 2019. Preoperative and postoperative hearing thresholds were recorded alongside potential ear environment risk factors. Multiple variable linear regression statistical analyses of risk factors were applied to determine independent association with postoperative pure tone average air\u2010bone gap (PTA\u2010ABG). Significant factors were used to generate a statistically\u2010weighted grading scale of Ear Environment Risk (EER).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>1679 cases had a mean follow\u2010up time of 33.6\u2009months (SD 36.3) and a mean postoperative PTA\u2010ABG of 21.2 (SD 12.8). Multiple revision status (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), presence of canal wall down mastoidectomy cavity (<jats:italic>p<\/jats:italic>\u2009=\u20090.020), absent malleus (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), absent stapes superstructure (<jats:italic>p<\/jats:italic>\u2009=\u20090.016), frequent otorrhea (<jats:italic>p<\/jats:italic>\u2009=\u20090.008), pediatric age (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and blunted\/lateralized tympanic membrane (<jats:italic>p<\/jats:italic>\u2009=\u20090.003) were independently correlated with PTA\u2010ABG. These factors were incorporated into an EER Scoring System with four distinct risk groups wherein each risk group was significantly correlated with PTA\u2010ABG, and this grading system was better correlated with PTA\u2010ABG (Kendall's <jats:italic>\u03c4<\/jats:italic>\u2009=\u20090.193) than other existing published grading scales.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Grading environment risk according to a novel EER scoring system generates meaningful risk groupings that correlate with ossiculoplasty postoperative PTA\u2010ABG, and this holds potential to frame reporting of hearing outcomes for future ossiculoplasty research.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3 <jats:italic>Laryngoscope<\/jats:italic>, 135:S1\u2013S11, 2025<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.31965","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T17:04:26Z","timestamp":1734973466000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A Multi\u2010Center Study of Ossiculoplasty Hearing Outcomes and a Grading Scale of Ear Environment Risk"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4503-5544","authenticated-orcid":false,"given":"Michael B.","family":"Gluth","sequence":"first","affiliation":[{"name":"Section of Otolaryngology\u2010Head and Neck Surgery, University of Chicago  Chicago Illinois U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2461-2904","authenticated-orcid":false,"given":"Ryan T.","family":"Judd","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."},{"name":"Pritzker School of Medicine, University of Chicago  Chicago Illinois U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9601-2628","authenticated-orcid":false,"given":"Richard K.","family":"Gurgel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Utah  Salt Lake City Utah U.S.A."},{"name":"University of Utah School of Medicine  Salt Lake City Utah U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L.","family":"Dornhoffer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Arkansas for Medical Sciences  Little Rock Arkansas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8041-5964","authenticated-orcid":false,"given":"Walter","family":"Kutz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery UT Southwestern Medical Center  Dallas Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jafri","family":"Kuthubutheen","sequence":"additional","affiliation":[{"name":"Division of Surgery University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan D.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Utah  Salt Lake City Utah U.S.A."},{"name":"University of Utah School of Medicine  Salt Lake City Utah U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Killeen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery UT Southwestern Medical Center  Dallas Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason H.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanda L.","family":"Fussell","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Mayo Clinic  Rochester Minnesota 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