Long-term results with hydroxylapatite middle ear implants

To Study the Pre Operative Indicators of Incudal Necrosis in Tubo-Tympanic Chronic Otitis Media

To assess the pre-operative indicators of incudal necrosis in tubo-tympanic CSOM. A total of 80 patients with tubo-tympanic type of CSOM attending the SMGS Hospital ENT OPD/IPD of both genders were enrolled for the study. Pre-operative findings on oto-microscopic examination, pure-tone audiometry, x-ray mastoid and intra-operative microscopy was recorded. It was found that patients with age > 30 years and more than 10 years of CSOM had had higher incidence of ossicular necrosis as compared to patients age < 30 years and less than 10 years of CSOM (P < 0.05). Patients who had granulation tissue and moderate to moderately severe hearing loss had higher incidence of ossicular necrosis as compared to other patients. The difference was seen significant (P < 0.05). In this study, it was observed that the presence of granulations over the perforation margins, disease persisting for more than 10 years, moderate to moderately severe hearing loss appear to be significant reliable indicators of incudal necrosis in tubo-tympanic type of CSOM. All patients of tubo-tympanic type of CSOM should be assessed in detail so as to reach early diagnosis of ossicular erosion that helps in surgical decision making and preparedness regarding ossiculoplasty and patient consent.

[Anatomical and functional results of ossiculoplasty with adjustable length titanium prostheses with and without hydroxyapatite]

OBJECTIVE

To compare the anatomical and functional results of the ossicular chain reconstruction with classic titanium adjustable prostheses and titanium adjustable prostheses with hydroxyapatite cap.

MATERIAL AND METHODS

The 300 patients (360 cases) with chronic suppurative otitis media were examined and operated. The patients are divided into 2 groups. Group A included patients who received an ossicular prosthesis with a hydroxyapatite cap (90 cases with a partial prosthesis and 90 with a full one). Group B included patients who received prostheses without hydroxyapatitis (90 cases with a partial prosthesis and 90 with a complete one). The patients who received a prosthesis with a hydroxyapatite cap were divided into two subgroups, depending on the autotissue, which was placed between the prosthesis cap and the nontympanic membrane: this is an autocartilage plate or perichondrium/fascial graft. The follow-up period after surgery was 38.5±14.4 months (from 12 to 48 months). In the long-term postoperative period, the subjects were assessed the values of the bone-air gap (BAG), the consistency of the nontympanic membrane, and the presence of signs of extrusion of the prosthesis cap. Comparison of anatomical and functional results between patients with full and partial ossicular prostheses was performed separately.

RESULTS

A good result in the form of a 20 dB or more dB BAG reduction was achieved in 82.2% of patients who received a partial prosthesis (85 patients in group A and 63 in group B), and in 57.8% of patients who received a complete prosthesis (45 patients in group A and 59 in group B). The BAG values in the long-term period after surgery did not statistically significantly differ between patients who received a prosthesis with a hydroxyapatite cap or a fully titanium one (p=0.939 for patients with full prostheses and p=0.745 for patients with partial prostheses). The placement of cartilage or perichondrium/fascial graft between the hydroxyapatite prosthesis cap and the nontympanic membrane also did not affect the functional outcome (with full prostheses - p=0.651, with partial prostheses - p=0.142).

CONCLUSION

It is possible to use ossicular prostheses with a hydroxyapatite cap without placing an autocartilaginous plate between the nontympanic membrane and the cap of the prosthesis. In the long term period, functional and anatomical results with hydroxyapatite cap prostheses do not differ statistically significantly from those with all-titanium prostheses.

Comparison of Titanium versus Polycel as Partial Ossicular Replacement Prosthesis: A Randomized Clinical Trial

INTRODUCTION

Each type of prosthesis for ossiculoplasty has its advantages and disadvantages, and the choice of the best material has been a matter of various studies. The present study aimed to make a comparison between the hearing outcomes of partial ossicular replacement prosthesis (PORP) using titanium versus Polycel prosthesis.

MATERIAL AND METHODS

A total of 106 patients undergoing PORP as a second stage ossiculoplasty were analyzed in this study. Following that, they were randomly assigned to two groups of titanium (n=54) and Polycel (n=52) prosthesis. Subsequently, pre-and post-operative audiometric data were assessed based on the aim of the study.

RESULTS

In general, the post-operative air-bone gap within 20 dB was given to 63.5% and 55.6% of all ears in the Polycel and titanium groups, respectively, indicating a non-significant difference (P=0.407). Finally, no SNHL was observed in the groups.

CONCLUSION

Overall, the hearing outcomes and the success rate of PORP are comparable between titanium and Polycel prostheses. Therefore, the selection of these prostheses could be based on the surgeons' preferences, availability, and cost.

Long-Term Stability of Two Thermoplastic Polymers Modified with Silver Nanoparticles

The aim of this study was to investigate the mechanical properties of polymeric composites prepared via extrusion and injection moulding. Four stable thermoplastic polymers were used as composites matrices (two kinds of polymethyl methacrylate and two kinds of co-polymer acrylonitrile-butadiene-styrene). Silver nanoparticles AgNPs were used as a modifying phase. Mechanical properties of testes materials were determined during the uniaxial stretching. Surface properties such as roughness and contact angle were also evaluated. The materials’ stability was assessed using scanning electron microscopy and non-destructive ultrasonic testing. All measurements were carried out at time intervals, determining both the initial parameters and after 6 and 12 months of incubation in deionized water. The obtained results proved that neither the preparation technology nor the amount of the modifier adversely affect the mechanical properties of the tested composites. The incorporated modifier does not change the surface properties significantly. The studies conducted after the materials’ incubation in water indicate their stability.

The efficiency of titanium middle ear prosthesis in ossicular chain reconstruction: our experience

Middle ear ossicular reconstruction is a challenging task for any otologist. Over a period of time, surgeons have tried various types of materials as ossicular prosthesis with varying amount of success. In the last decade, numerous studies have been conducted that have proved that titanium prosthesis is biocompatible. We have conducted this study to investigate the efficiency of titanium middle ear prosthesis (Eon Meditech Pvt. Ltd.) in tympanoplasty. Nineteen patients who underwent tympanoplasty with titanium prosthesis placement from January to October 2010 were included in the study. Fifteen patients underwent reconstruction using titanium PORP while four patients required titanium TORP. The average follow up period was 11.1 months. The pre-operative and post-operative PTAs and the closure of the air-bone gap (ABG) at 0.5, 1, 2, 3 KHz (as per the AAO-HNS guidelines) were analyzed. As per the Indian speech and hearing association (ISHA) guidelines, the patients were classified into groups based on the amount of hearing loss. The improvement in the mean PTA (AC) was 16.21 dB in the PORP group while it was 20.47 dB in the TORP group (P value < 0.05). According to ISHA guidelines, 18 out of 19 (94.8%) patients had either a normal hearing or a mild hearing loss post-operatively. The overall success rate (post-operative ABG ≤ 20 dB) of this series is 68.4%. In this series, there has been no extrusion of the prosthesis. Titanium prosthesis is delicate, easy and quick to handle. They are efficient and suitable implants for middle ear ossicular reconstruction. The use of cartilage between the prosthesis and the graft helps to prevent extrusion of the prosthesis.

A new resorbable bone void filler in trauma: early clinical experience and histologic evaluation

Six patients with traumatic bone injuries were treated by packing ultraporous beta-tricalcium phosphate (beta-TCP), a synthetic bone void filler, into defect sites using firm finger pressure. Radiographs showed new bone consolidating in treated sites after as little as 2 months. A biopsy obtained from a fractured calcaneus 9 months after surgery showed new bone growing within the ultraporous scaffold. Regions of newly mineralized bone and woven bone in the scaffold suggested that the defect site was undergoing repair. Some new bone had developed lamellar architecture. Higher radiodensity and slower resorption of ultraporous bone void filler in this human case, relative to that seen in a canine study, is attributed to slower metabolism in humans relative to dogs and to greater packing pressures used in the clinic. The histology specimen did not indicate untoward inflammatory response or significant foreign body reaction. Thus, this first human histology report supports the use of biocompatible ultraporous beta-TCP to enhance new bone formation in bone defects.