Ossiculoplasty with total hydroxylapatite prostheses anatomical and functional outcomes

Total ossicular chain reconstruction using a titanium prosthesis: functional results

PURPOSE

To evaluate the efficacy and safety of a titanium total prosthesis (TORP) in ossicular chain reconstruction.

METHODS

Retrospective analysis of 113 cases of total ossicular chain reconstruction performed by a single surgeon between 2006 and 2018. Follow-up lasted until January 2020. Participants were patients with chronic otitis media, cholesteatoma, or ossicular chain disruption.

RESULTS

Mean preoperative air-bone gap (± standard deviation) was 32.74 dB (± 11.62). Mean postoperative air-bone gap was 21.68 (± 11.29). Mean air-bone gap improvement was 11.06 dB (± 14.99) (p < 0.001). 57 cases had a post-operative air-bone gap smaller than or equal to 20 dB (50.44%). In four cases, prosthesis dislocation was observed (12.39%). Mean prosthesis length in this group was 5.29 mm (± 0.86) versus 4.36 mm (± 1.02) in cases without prosthesis dislocation (p = 0.002).

CONCLUSIONS

Total ossicular reconstruction using a titanium prosthesis yields favorable functional results, also during prolonged follow-up. Prosthesis length was significantly longer in cases with prosthesis dislocation.

Audiometric Outcomes Comparing Endoscopic Versus Microscopic Ossiculoplasty

OBJECTIVE

To assess endoscopic and microscopic ossiculoplasty audiometric outcomes.

STUDY DESIGN

Retrospective review.

SETTING

Tertiary academic center.

PATIENTS

Adult patients who underwent ossiculoplasty with either partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) from 2010 to 2019 with at least 1 year of audiometric follow-up were included.

INTERVENTIONS

Endoscopic or microscopic ossiculoplasty.

MAIN OUTCOME MEASURES

Postoperative air-bone gap (ABG) after at least 1 year.

RESULTS

A total of 198 patients, 53.5% female, and a median age of 47.5 years, met inclusion criteria. 64.1% of patients were reconstructed with a PORP, and 31.8% were reconstructed using an endoscopic approach. The median audiometric follow-up was 27 months. The median postoperative ABG was 16.9 dB overall, 15.6 dB for PORP reconstruction, and 19.4 dB for TORP reconstruction (PORP versus TORP, p = 0.002). For TORP reconstructions, the median ABG for both endoscopic and microscopic TORP was 19.4 dB (p = 0.92). For PORP reconstructions, the median ABG for endoscopic PORP was 12.3 dB compared with 16.3 dB for microscopic PORP (p = 0.02). Using multivariate linear regression to predict postoperative PORP ABG, and controlling for age, prior ossiculoplasty, middle ear mucosal disease (granulation, fibrosis, polyposis), middle ear atelectasis, myringitis, contralateral middle ear disease, and use of byte prostheses, endoscopic PORP reconstruction was associated with improvement in ABG over the microscopic approach by 4.4 dB (p = 0.04).

CONCLUSIONS

For PORP ossiculoplasty procedures, endoscopic ossiculoplasty is associated with improved postoperative ABG compared with microscopic ossiculoplasty.

[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.

Long-term histological results of ossicular chain reconstruction using bioceramic implants

Middle ear problems are addressed using tympanoplasty, which requires a mobile tympanic membrane and secure sound-conducting mechanism. The present is a long-term, retrospective, non-controlled study on the results of ossiculoplasty using bioceramic implants of autochthonous origin and which defined the statistical relevant factors that could influence the rate of implant rejection. In a cohort of 108 patients ossiculoplasties with bioceramic implants were performed and patients were followed up clinically for a period of minimum 7 years. Several factors were identified that could influence the results of the implantation and the statistical correlations were studied. The rejection rate after 9.12 years was 21% (23 patients). Histological integration rate was 79% (85 patients), similar to results reported in literature for both bioceramic and titanium implants. Hydroxyapatite has many of the ideal characteristics required to be a good prosthesis with a high degree of biocompatibility, very low extrusion rate, low risk of disease transmission and good functional results. Although perhaps considered of historical interest, bioceramic implants are cheaper and can be produced locally, which is a great advantage for struggling economies.

Anatomical and functional results of ossiculoplasty using titanium prosthesis

Titanium ossicular chain replacement prosthesis is often used for rehabilitation of the columellar effect in otologic surgeries. This retrospective study aims to analyse the anatomical and functional results of surgeries in which a titanium prosthesis was used. Two hundred and eighty procedures in 256 patients operated on in a tertiary referral center were analysed. Aetiologies, preoperative audiograms, peroperative data and postoperative outcomes at 2 and 12 months postoperatively were reviewed. Chronic suppurative otitis media with or without cholesteatoma was the main aetiology (89%). There was no difference in anatomical results between partial and total ossicular replacement prosthesis, with an overall dislocation rate of 6%, and an overall extrusion rate of 3%. Regarding functional results, a postoperative air-bone gap ≤ 20 dB was achieved in 65% of cases, with a better result for partial compared to total ossiculoplasty (p = 0.02). A significant difference in air bone gap closure was found when comparing aetiologies, with a higher air-bone gap closure in malformation cases compared to chronic suppurative otitis media with cholesteatoma or retraction cases (p = 0.03). Ossiculoplasty using titanium prosthesis is a safe and effective procedure for rehabilitation of hearing loss, which allows reaching an air-bone gap ≤ 20 dB in the majority of patients.

Titanium Ossicular Chain Reconstruction Revision Success and Preoperative Factors Predicting Success

Objective Determine rates of success after revision titanium ossicular chain reconstruction with either partial or total ossicular replacement prosthesis and assess preoperative factors predicting positive outcomes. Study Design Case series with planned data collection. Setting Tertiary hospital. Subjects and Methods The charts of 76 surgical patients who underwent revision titanium ossicular chain reconstruction from 2003 to 2014 were abstracted from a prospectively maintained database at the Medical University of South Carolina. Postoperative air-bone gap (ABG) after revision surgery at short-term (<6 months) and intermediate to long-term (>1 year) follow-up and preoperative factors associated with postoperative ABG ≤20 dB were recorded. A paired t test or Wilcoxon signed-rank sum test was utilized to compare preoperative, short-term, or intermediate to long-term results. Results Seventy-six patients underwent revision ossiculoplasty and met inclusion criteria. Mean postoperative ABG was 22.5 at short-term follow-up ( P < .0001) and 24.4 at intermediate to long-term follow-up ( P = .003). Postoperative ABG ≤20 dB was achieved in 51.5% of patients. The only preoperative factor associated with postoperative ABG ≤20 dB was location of original primary ossiculoplasty ( P = .01). Conclusions This is one of the larger studies involving revision titanium ossiculoplasty. Revision surgery showed a significant improvement in postoperative ABG. The location of the original ossiculoplasty correlated with success of revision surgery (defined as postoperative ABG ≤20 dB). Patients who had the primary ossiculoplasty at an outside hospital may have better audiometric outcomes than patients who had it at a tertiary hospital.

Bony ankylosis of hydroxyapatite prostheses in the middle ear

BACKGROUND

Ossiculoplasty is a commonly performed middle ear procedure. Ossicular chain reconstruction (OCR) prostheses should be made of a biocompatible material; one such common material is hydroxyapatite (HA).

METHODS

2 patients were identified who had HA OCR prostheses which had fused to the middle ear bony structures. One HA OCR had fused to the fallopian canal in the tympanic segment and represented a management dilemma. The other fused to the scutum.

CONCLUSION

Bony ankylosis of a HA containing OCR prosthesis should be considered in the differential diagnosis of a failed ossiculoplasty. Depending on the location of the fusion, special measures may be needed to free the prosthesis from the underlying middle ear structures.

Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults

Surgical management of cholesteatoma limited to the attic and/or mesotympanum remains controversial. The aim of this study is to evaluate the anatomical and the functional results of trans-canal atticotomy in this pathological condition. The records of 27 adult patients treated from 2008 to 2014 who underwent trans-canal atticotomy for primary cholesteatoma surgery were reviewed. Pre-operative physical examination, audiometry, and CT-scan have been analyzed. Intraoperative findings have been described as well as the surgical technique. Anatomical and functional results have been evaluated with a mean follow-up of 24 ± 12.2 months, and the results of a CT-scan performed 1 year after surgery were examined to assess the presence of residual disease. Surgeries were uneventful. During the follow-up, 1 patient (4 %) experienced a retraction of the attical reconstruction; all the other patients had a well-healed tympanic drum with stable attical reconstruction. The mean air-bone gap was 19 ± 12.2 and 10 ± 7.3 dB pre-operatively and post-operatively, respectively (mean ± SD, p = 0.001, paired t test). Twenty-two patients (81 %) had no opacity suggesting residual cholesteatoma in CT-scan. Four patients (15 %) presenting an opacity at CT-scan underwent MRI study that was negative for residual cholesteatoma. One patient (4 %) had displacement of the ossicular prosthesis. In conclusion, cholesteatomas restricted to the attic and/or mesotympanum can be removed in a one-stage technique with no visible residual at 1 year, and with closure of the air-bone gap by 50 %.

Biomechanical strength of glass ionomer cement in incudostapedial rebridging

OBJECTIVE

To study the biomechanical properties of glass ionomer cement used for incudostapedial rebridging.

METHODS

Two groups were established based on the size of the gap between the incus and stapes (1.0 mm in group 1 and 2.0 mm in group 2). Glass ionomer cement was applied to the gaps, and compression tests were performed. Maximum force was measured at the fracture point, and was divided by the cross-sectional area to obtain the maximum compressive strength.

RESULTS

No significant difference was found in the maximum force for the two groups (p = 0.312). The glass ionomer cement diameter was significantly higher in group 2 than in group 1 (p = 0.006). The maximum compressive strength was significantly higher in group 1 than in group 2 (p = 0.042).

CONCLUSION

The fragility of bone cement used in this study was 25.5 per cent higher for a 2 mm gap than for a 1 mm gap. We speculate that the use of bone cement may be safer for the repair of smaller incudostapedial defects.

PORP vs. TORP: a meta-analysis

After the surgical procedure of ossicular chain reconstruction, the effectiveness and/or stability of partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) were systematically compared and evaluated using meta-analysis. A total of 40 eligible investigations with 4,311 subjects were included in our study. There was a significant difference in the effectiveness of the reconstruction of the ossicular chain between PORP and TORP; the data showed a combined risk ratio (RR) of 1.28 (95 % CI 1.17-1.41, p < 0.00001), but no notable difference was obtained in staged procedures subgroup and cholesteatoma subgroup, with a combined RR of 1.13 (95 % CI 0.60-2.11, p = 0.70) in staged procedures subgroup and RR of 2.60 (95 % CI 0.20-36.21, p = 0.59 in cholesteatoma subgroup). There was a statistically significant difference in the stability of the prostheses in long-term follow-up, with a combined RR of 0.37 (95 % CI 0.16-0.85, p = 0.02), but no significant difference was observed in the total sample, with a combined RR of 0.64 (95 % CI 0.40-1.03, p = 0.06). Our overall results suggest that the effectiveness of PORP was higher than TORP, except within staged procedures subgroup and cholesteatoma subgroup. In addition, the stability of PORP was significantly superior to TORP in long-term follow-ups, but no significant effect was detected in the general study.

Hearing results using titanium ossicular replacement prosthesis in intact canal wall tympanoplasty for cholesteatoma

CONCLUSIONS

Titanium proved to be a valuable alternative to ossicles in ossiculoplasty procedures. Complication rates are comparable to those obtained by other authors with titanium and nontitanium prostheses. Hearing results were worse compared with other reports; however, no conclusion can be drawn on the basis of the literature because of the heterogeneity of the populations studied.

OBJECTIVES

To evaluate the results and complications of total (TORP) and partial (PORP) titanium ossicular replacement prostheses in middle ear cholesteatoma.

METHODS

Fifty-seven patients affected by acquired cholesteatoma of the middle ear undergoing titanium ossiculoplasty during second stage intact canal wall tympanoplasty were evaluated. Postoperative hearing gain, complication rate, and revision rate were analyzed.

RESULTS

Average postoperative gain was 13.6 dB HL for PORP and 17.9 dB HL for TORP. After ossicular reconstruction the mean postoperative ABG was 24.1 dB HL in PORPs and 27.2 dB HL in TORPs. The difference in air-bone gap (ABG) between the two groups after ossiculoplasty was not significant. The number of patients with an ABG > 30 dB was higher in the TORP group compared with the PORP group (p = 0.024) after ossicular reconstruction. The total extrusion rate was 5.2% and the total revision rate was 10.5%.

Outcome of ossiculoplasty in Kyoto University Hospital

CONCLUSION

We performed ossiculoplasty under conditions preventing inflammation by adopting a planned staged operation, which is suitable for ossiculoplasty using an artificial prosthesis. We identified the presence of chorda tympani nerve as a candidate predictive factor for successful ossiculoplasty.

OBJECTIVES

We aimed to summarize the outcome of ossiculoplasty and to find factors to improve the success rate.

METHODS

This was a retrospective chart review of 96 patients who underwent ossiculoplasty in Kyoto University Hospital from 2001 to 2008. Patients' backgrounds, hearing outcomes, and surgical procedures were analyzed. To find predictive factors for successful ossiculoplasty, we performed logistic regression analysis.

RESULTS

The improvement in the mean air conduction level was 12.9 dB. The mean postoperative air-bone gap (ABG) was 25.0 dB. The ABG decreased to within 20 dB in 40.7% of the cases. As a result of univariate logistic regression analysis, primary or planned second stage surgery, closed mastoid cavity, and presence of the chorda tympani nerve were identified as favorable factors for successful ossiculoplasty.

Development of tissue-engineered substitutes of the ear ossicles: PORP-shaped poly(propylene fumarate)-based scaffolds cultured with human mesenchymal stromal cells

This is a novel study aimed at exploring possible tissue engineering (TE) options for fabricating middle ear ossicle replacements. Alternatives to prosthetic replacements currently used in ossiculoplasty are desirable, considering that current devices are known to suffer from a persistent rejection phenomenon, known as extrusion. In this study a biocompatible and biodegradable polymer, poly(propylene fumarate)/poly(propylene fumarate)-diacrylate (PPF/PPF-DA), was chosen to assess the fabrication feasibility of highly porous devices shaped as partial ossicular replacement prostheses (PORPs). PORP-like scaffolds were produced, and their poral features (porosity and pore interconnectivity) were evaluated via micro-CT. In addition, their capability to support human mesenchymal stromal cell (hMSC) colonization and osteoblastic differentiation in vitro was investigated with both quantitative and qualitative analyses. This report summarizes and discusses all the fundamental issues associated with ossicle prosthetization as well as the challenging opportunities potentially offered to middle ear reconstruction by TE; moreover it demonstrates that PPF/PPF-DA PORP-like scaffolds can be appropriately fabricated to allow both the colonization of hMSCs and their osteoblastic maturation in vitro. Specifically, the expression patterns of the main osteogenic markers (alkaline phosphatase, calcium) and of various matrix biomolecules (glycoproteins, glycosaminoglycans, collagen I) were studied. These preliminarily obtained outcomes may launch a new trend in otology dedicated to TE ossicle development to improve on the performance of current prosthetic replacements.

Ossicular reconstruction: incus versus universal titanium prosthesis

OBJECTIVES

The main purpose of this study is to compare audiological outcomes of incus reconstruction, Xomed Medtronic universal titanium partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP). We also compared results based on surgical technique, history of previous surgery, form of the prosthesis head, pathology and frequency.

METHODS

A chart review was performed and included reconstructions performed between June 2003 and December 2006. Results were based on air-bone gap and pure tone average.

RESULTS

Postoperative mean air-bone gap and mean pure tone average are significantly lower using incus reconstruction compared with the titanium prosthesis groups. PORP and TORP groups yielded similar outcomes. Closure of ABG is similar in all three groups. Postoperative results were better using an intact canal wall mastoidectomy compared with a canal wall down technique, but ABG closure was similar in both groups. Primary surgeries gave better results than revisions of reconstructions performed by the senior author or elsewhere.

CONCLUSION

Though Xomed Medtronic titanium prostheses are effective in ossicular reconstruction, incus reconstruction is at least as effective when feasible. Canal wall down mastoidectomy should be reserved for cases where preservation of the canal wall is contraindicated. Previous same ear surgery is a poor prognostic factor for successful outcome. Preliminary results indicate that round head PORPs may be superior to their oval head counterparts.

Cartilage-wire-fascia compact total ossicular replacement prosthesis in one-stage cholesteatoma surgery

PURPOSE

Retraction pocket and extrusion of the ossicular prosthesis remain significant problems after tympanoplasty in cholesteatoma surgery. This study presents an alternative surgical technique with a total compact ossicular prosthesis including cartilage, wire, and temporalis fascia.

MATERIALS AND METHODS

A total of 42 patients (27 adults, 15 children) underwent an ear operation for cholesteatoma requiring total ossicular chain replacement during a 10-year period. Surgery included canal wall down mastoidectomy and reconstruction of the middle ear in one stage. The total ossicular replacement prosthesis was made by a stainless steel wire passed and secured through a piece of conchal cartilage and temporalis fascia positioned on the free end of the wire. The analysis of our data included hearing results pre-surgery and post-surgery, complications recorded in the case notes, and postoperative otoscopic findings.

RESULTS

The mean air-bone gap decreased from 39.2 to 22.4 dB in the early postoperative period (mean follow-up, 12.8 months). Eight patients with a long-term follow-up (mean, 7.1 years) presented a small deterioration of their postoperative hearing improvement. The bone conduction did not present significant changes. Three patients developed postoperative infection and treated successfully with medical therapy. No significant complications as displacement or extrusion of the prosthesis and retraction pocket were detected postoperatively.

CONCLUSION

This is an alternative tympanoplasty technique with a stable cartilage-wire-fascia total ossicular prosthesis. This technique has a low complication rate; good hearing results and offers another surgical option to the surgeon especially for cases where the cost is a concern.

Biomaterials for tissue reconstruction and bone substitution of the ear, nose and throat, face and neck

The role of biomaterials has become more important in the last 30 years in otorhinolaryngology. Legal directives for their use and, more importantly, indications have been specified. Biomaterials are medical devices, designed for tissue substitution or reconstruction. Approval labeling is issued in the form of European Community certification and postmarketing medical device safety in Europe - completely independent from the US FDA's certification. The indications for biomaterials are generally similar to those of autografts. Their main advantage is that they limit the morbidity caused by autograft harvesting. The benefits are aesthetic, functional or both. The main indications are in otology, sinus surgery, cranio-maxillo-facial traumatology, osteosynthesis and orthognatic surgery, skeletal augmentation and anti-aging surgery, facial prosthetic rehabilitation and laryngology. The research fields are extremely varied (e.g., increased therapeutic properties, drug-delivery systems or tissue engineering). Increasingly, biomaterials are implanted and the surgical success of their use is dependent upon strict legal labeling and well-defined indications.

Biomatériaux de reconstruction et de comblement osseux en ORL et chirurgie cervicofaciale

INTRODUCTION

Position of medical devices has increased for last 30 years in otorhinolaryngology. Legal directive of use, main indications and perspectives are presented.

RESULTS AND DISCUSSION

Biomaterials are medical devices planned for tissue reconstruction or substitution. The approval labelling are planned in Europe by the European Community certification (marquage CE) and overseen by a postmarket medical device safety (matériovigilance), that are completely independent from the Food and Drug Administration certification. Indications of biomaterials are likely competitive to those of autografts; their advantage is to limit the morbidity due to autograft harvesting. Benefits are aesthetics, functional or complementary. Main indications are presented in otology, rhinology, face traumatology, laryngology, anti-aging surgery, implants and epithesis. Research fields are scanned (increased therapeutic properties, drug delivery systems, tissue engineering...).

CONCLUSION

Biomaterials are increasingly implanted in ENT surgery. The surgical success of their use require a strict legal label and well-defined indications.

Audiometric outcomes of tympanoplasty with hydroxylapatite prosthesis: consultant versus trainees

OBJECTIVE

To assess and compare the audiometric outcomes and surgical complication rates of tympanoplasty with hydroxylapatite (HA) prostheses performed by a single consultant and advanced trainees.

STUDY DESIGN

A retrospective case review was undertaken.

SETTING

Tertiary referral center.

PATIENTS

One hundred eighteen cases of primary and revision tympanoplasty were included in the study performed during a 6-year period.

INTERVENTION

Tympanoplasty with HA prosthesis.

MAIN OUTCOME MEASURES

Preoperative and postoperative audiometric data were compared for both the consultant and trainee groups. Details of the surgical procedure and operative complications were also recorded.

RESULTS

Fifty-eight procedures were performed by the consultant and 60 operations were performed by trainees. The average improvement in air-bone gap (ABG) for consultants was 14.8 dB, with a 95% confidence interval (10.4, 19.2) (paired t test; test statistic: t=6.80, 57 df, p<0.01), whereas for trainees, the average improvement in ABG was 7.8 dB, with a 95% confidence interval (4.1, 11.6) (paired t test; test statistic: t=4.19, 59 df, p<0.01). The difference of 7.0 dB in mean ABG between the 2 groups was significant (two-sample t test; test statistic: t=2.44, 116 df, p=0.02). There was no significant difference in the surgical procedure or in the number of revision operations performed by the consultant or trainees. Surgical complication rates were comparable for the two groups.

CONCLUSION

In this series, the consultant achieved a significantly better closure in ABG than trainees for tympanoplasty with HA prostheses.

Hearing results after ossiculoplasty using Polycel prosthesis

CONCLUSIONS

Polycel is an effective material to use in ossiculoplasty. Good prognostic factors for hearing improvement after ossiculoplasty were healthy middle ear mucosa and the presence of stapes superstructure.

OBJECTIVE

During the last decade, the surgical use of alloplasts has become increasingly widespread among otologists. This study aimed to evaluate the hearing results after ossiculoplasty using Polycel prosthesis.

MATERIALS AND METHODS

We retrospectively reviewed 188 patients who underwent ossicular chain reconstruction using Polycel prosthesis and were followed up postoperatively for more than 12 months at Severance Eye-ENT Hospital from 1998 to 2002. Postoperative hearing results were assessed by measuring the postoperative air-bone gap (ABG) and closure of the ABG. Successful postoperative ABG criteria were defined as the following three measurements: ABG of <or=10 dB, ABG of <or=20 dB, and ABG of <or=30 dB. Several prognostic factors were analyzed, including the condition of the middle ear mucosa and ossicles, the presence or absence of cholesteatoma, surgical method, and staging and revision surgery.

RESULTS

Of the 188 cases, 22 cases (11.7%) showed an ABG of <or=10 dB, 96 cases (51.1%) presented with an ABG of <or=20 dB, and 158 cases (84.0%) had an ABG of <or=30 dB. In cases with healthy middle ear mucosa and the presence of stapes superstructure, the hearing results were good.

Ossiculoplasty

Contemporary surgical techniques for treating various pathologies affecting the middle ear address not only eradication of the underlying disease process but also restoration of normal auditory function. Trauma, neoplasms, inflammatory processes, and cholesteatomas can erode and alter normal middle ear components and relationships vital for the transmission of auditory energy to the inner ear. Over the last five decades, various ossiculoplasty techniques and prostheses have been studied and reported in the literature. Unfortunately, the multitude of reconstructive techniques attests to the fact that none of the currently available methods are ideal.

Längenvariable Titanprothesen bei Typ-III-Tympanoplastik

INTRODUCTION

For type III tympanoplasty by partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), the length of the prosthesis must match the individual intraoperative anatomical and physiological characteristics.

MATERIALS AND METHODS

Databanks were used to determine the necessary sizer length of the sizer disc. The measurement template for the size of the cartilage to overlay the prosthesis headplate was derived from the headplates of the Tübinger titanium prostheses (TTP) and the Dresdener titanium prostheses. Finally all functions were integrated into a synthetic plate.

RESULTS

The result was a simple and reasonably priced disposable multifunctional instrument (Tübinger sizer disc TSD) which allowed an exact measurement for every prosthesis in TORP and PORP. For the TTP-Variac, the TSD enabled the simple intraoperative production of prostheses with the length desired by the surgeon. For PORP the TSD enabled an adaptation of the diameter of the prosthesis foot for TTP, TTP-Vario and TTP-Variac and provided a template for the size determination of the cartilage overlay of the titanium prosthesis head. The sizers and the resulting prostheses were used for initial tympanoplastic operations. Audiometric investigations carried out 6 weeks postoperatively gave results corresponding to those previously obtained in a study with TTP and TTP-Vario using the old instrumentation.

CONCLUSIONS

The new instrumentation leads to an improvement of the intraoperative practicability and a simplification. The audiological results remain the same.

Hearing results with the titanium ossicular replacement prostheses

The purpose was to study the hearing results in patients receiving a Kurz titanium Bell partial ossicular replacement prosthesis (PORP) or an Aerial total ossicular replacement prosthesis (TORP). The study was a retrospective chart review in a tertiary otologic referral center. A computerized otologic database was used to identify 111 patients implanted with either a PORP or TORP prosthesis. Audiograms were reviewed and air-bone gaps were calculated for each patient. The improvement of the average air-bone gap (ABG) was 10.2 and 12.7 dB at 3 and 20 months after ossiculoplasty, respectively. Sixty-six percent of patients (73/111) had a postoperative air-bone gap of 20 dB or less. The ABG for the titanium PORP prosthesis was 14.3+/-9.7 dB, compared with 25.2+/-13.7 dB for the TORP prosthesis (P <0.05). The ABG to within 20 dB or less was obtained in the PORP group in 77% of the cases, versus 52% of the cases in the TORP group (P <0.05). Two extrusions of the prostheses were observed at 17 and 20 months after surgery (1.8%). Revision procedures for functional failure were carried out in 20 patients (18%). The rate of sensorineural hearing loss was 3.6%. The major factors influencing good audiometric results were the surgical procedure preserving the external auditory canal and the presence of the stapes. The best hearing results were achieved when a PORP was used in an intact canal wall (ICW) procedure, and the worst hearing results were achieved when a TORP was used in a canal wall down (CWD) procedure. The titanium Kurz prosthesis has been an effective implant at our institution for ossicular reconstruction.