Short- and long-term results of ossicular reconstruction using partial and total plastipore prostheses

[Application of combined ossicular replacement prosthesis and total ossicular replacement prosthesis of type Ⅲ tympanoplasty]

Objective:This study investigated the application of combined ossicular replacement prosthesis（The Kurz Omega Connector+TORP） in type Ⅲ tympanoplasty, and compared the surgical effect with traditional TORP. Methods:Twenty patients with unilateral chronic suppurative otitis media diagnosed in the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2019 to June 2020 were included in this study.All the patients were treated with intra-auricular incision with a microscopic approach（tympanic exploration, lesion clearance+type Ⅲ tympanoplasty）. According to the placement of different types of ossicular replacement prosthesis in the ossicular chain reconstruction of type Ⅲ tympanoplasty, the patients were divided into two groups: the traditional TORP group（n=10） and the combined ossicular replacement prosthesis（The Kurz Omega Connector+TORP） group（n=10）. All patients underwent pure tone audiometry before and 1 year after the operation, and the average hearing threshold and air-bone conduction difference（ABG） were compared between the two groups before and after the operation. Results:The reconstruction of the ossicular chain was completed successfully in all patients. Endoscopic examination showed that the epithelialization of the operative cavity was good and the repair of the tympanic membrane recovered well one month after the operation. There was no significant difference in preoperative mean airway threshold between the combined ossicular replacement prosthesis and the traditional TORP group （74.13[41.50，80.50] dB vs 74.25[44.81，82.50] dB, P>0.05）, there was no significant difference in preoperative ABG （55.63[21.50，61.25] dB vs 54.13[23.63，60.38] dB, P>0.05）. After the operation, the ABG of the combined auriculus group was significantly lower than that of the traditional operation group （12.00[5.75，24.56] dB vs 34.88[14.19，46.44] dB, P<0.05）. Conclusion: The combined ossicular replacement prosthesis（The Kurz Omega Connector+TORP） can increase the stability of hearing reconstruction and improve hearing in type Ⅲ tympanoplasty.

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.

Evaluation of Outcomes Related to Hearing and Tinnitus After Ossicular Chain Reconstruction

OBJECTIVE

The aim of this study was to evaluate both audiological and tinnitus related results in patients with tinnitus undergoing ossicular chain reconstruction (OCR) for ossicular chain injury.

METHODS

Between January 2015 and January 2019, patients who underwent OCR due to ossicular chain pathology and developed tinnitus symptoms were included in the study group. Middle ear pathologies were standardized using the middle ear risk index (MERI) scoring system and the tinnitus handicap inventory (THI) was used to determine the severity of tinnitus. The surgical methods used for reconstruction were partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), depending on the patient's pathology.

RESULTS

The study group consisted of 43 patients aged between 34 and 65 years. Mean MERI score of the patients was 6.42 ± 2.52. When assessed categorically, 18.6% of the study group was identified in the 'mild', 46.5% were in the 'moderate', and 34.5% were in the 'severe' MERI category. Patients in the TORP group and those who were undergoing second session OCR had higher MERI and preop THI scores. Post-operative tinnitus levels were higher in patients who had OCR in the second session and were in the severe risk group. The ABG and tinnitus scores of patients were found to improve with OCR. In patients who underwent TORP, both ABG and tinnitus scores decreased significantly. Whereas, in patients who underwent PORP, only ABG values decreased significantly. After OCR, both ABG value and tinnitus scores significantly decreased compared to pre-operative results. ABG recovery rate was 100% in the study group.

CONCLUSION

It can be said that OCR positively changes both audiological parameters and tinnitus levels in ossicular chain pathologies.

Utilization of incus with bone cement for total ossicular reconstruction

Background: Total ossicular chain reconstructions are performed to connect mobile stapes footplate and tympanic membrane. Data on the use of incus for total ossicular reconstruction is quite limited in the literature. Objective: The main objective of this study is to describe a novel surgical method that utilizes incus with bone cement to stabilize the ossicular chain for total ossicular reconstruction. Materials and methods: 16 patients who underwent total ossicular reconstruction using our method were included in this study. We evaluated hearing by comparing preoperative and postoperative air-bone gap (ABG), air conduction (AC) and bone conduction (BC). The percentage of patients achieving ABG ≤20 dB was determined. Results: The mean preoperative ABG was 35.3 ± 8.2 and postoperative ABG decreased significantly to 23.7 ± 7.6 (p < .001). The mean preoperative AC (57.5 ± 10) decreased significantly postoperatively to (46.5 ± 13.3)(p = .014). There was not any difference between pre- and post-operative BC. We achieved successful hearing results (ABG ≤ 20dB) in 44% of patients. Conclusion: The use of incus with bone cement stabilization for total ossicular reconstruction seems a feasible option. Good hearing outcomes, and low cost, complication, and extrusion rate may be the main reasons to prefer this method.

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.

Long-term Outcomes of Titanium Ossiculoplasty in Chronic Otitis Media

Objective

The primary objective is to report long-term hearing outcomes (>2 years) after titanium ossiculoplasty in patients with chronic otitis media.

Study Design

Case series with chart review.

Setting

Tertiary care hospital.

Subjects and Methods

In total, 156 patients with chronic otitis media undergoing titanium ossiculoplasty were included. The primary outcome measure was the long-term postoperative ABG. The stability of hearing over time was determined by comparing short-term and long-term postoperative air-bone gap (ABG). Secondary outcome measures included ΔABG, postoperative speech reception thresholds, air-conduction pure-tone average (AC PTA), word recognition scores, and percentage of patients achieving ABG ≤20 dB. Revision and extrusion rates were examined.

Results

At short-term follow-up (<6 months), mean postoperative ABG was 18.4 ± 10.6 dB and AC PTA was 31.7 ± 15.2 dB; 67% of patients achieved ABG ≤20 dB. At long-term follow-up (>2 years), mean ABG was 20.0 dB ± 15.4 and AC PTA was 35.3 ± 16.1 dB; 60% of patients achieved ABG ≤20. At both short- and long-term follow-up, ABG and AC PTA were significantly improved compared with preoperative values. No difference in hearing outcomes was observed when comparing partial titanium ossicular prostheses (PORPs) to total titanium ossicular prostheses (TORPs) at either short- or long-term follow-ups. In patients with both short- and long-term follow-up (n = 50), deterioration in hearing was noted (3.4 dB, P = .04). When analyzed by type of prosthesis, PORPs demonstrated statistically significant deterioration in ABG over time (4.9 dB, P = .02), while TORPs did not (2.5 dB, P = .50). The long-term extrusion rate was 3.2%.

Conclusion

With a minimum follow-up of 2 years, titanium ossiculoplasty provides good long-term hearing results. Modest deterioration in hearing is noted over time.

Long-term outcome of ossiculoplasty using autogenous mastoid cortical bone

OBJECTIVE

To observe the long-term outcome of ossiculoplasty using autogenous mastoid cortical bone in chronic otitis media in-patients.

METHODS

Sixty-one ears of 57 in-patients with chronic otitis media, with or without cholesteatoma, underwent type III tympanoplasty using autogenous mastoid cortical bone as the prosthetic material. Twenty-one ears were treated by canal wall down mastoidectomy and 40 ears by canal wall up mastoidectomy. The follow-up period was 3 to 6 years (average 4.2 years). Pure tone averages for thresholds at 0.5, 1, 2 and 3 kHz were calculated using standard conventional audiometry.

RESULTS

The pre-operative mean air-bone gap of 31.6 dB, for all ears, was reduced to 20.3 dB post-operatively. For the 40 canal wall up ears, this value decreased from 30.8 dB to 19.9 dB, and for the 21 canal wall down ears it decreased from 33.0 dB to 21.0 dB. The differences between the pre- and post-operative mean air-bone gap values were significant.

CONCLUSION

No cases of extrusion, necrosis or resorption were exhibited for the autogenous mastoid cortical bone prosthesis. A significant hearing improvement was obtained in the majority of cases and this remained stable over time.

Ossicular reconstruction for incus long-process defects: bone cement or partial ossicular replacement prosthesis

OBJECTIVE

The objective of this study was to compare hearing results in patients undergoing ossiculoplasty with bone cement (BC) vs partial ossicular replacement prosthesis (PORP) in cases of incudostapedial discontinuity during tympanoplasty surgeries.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary referral center.

SUBJECTS

A total of 44 patients with incudostapedial discontinuity, 21 operated on with BC and 23 operated on with PORP, were enrolled in this study.

METHODS

Preoperative and postoperative audiograms at 12 months were evaluated. Pure-tone averages and air-bone gaps (ABGs) were calculated according to the guidelines.

RESULTS

The ABG was 26.61 dB preoperatively and 9.76 dB postoperatively in the BC group. The hearing gain in ABG was statistically significant (P = .0001). The preoperative and postoperative ABGs in the PORP group were 29.48 and 8.89 dB, respectively. The hearing gain in ABG was statistically significant (P = .0001). When the groups were compared for mean gains in the ABG, the difference was not statistically significant (P = .192). The postoperative ABG of less than 20 dB was achieved by 90.4% in the BC group and 86.9% in the PORP group. This difference was not statistically significant (P = .745). No adverse reactions or complications were observed.

CONCLUSIONS

Both BC and PORP are reliable and efficient methods for the repair of incudostapedial joint defects. There is no difference between these 2 methods, based on the hearing results. Additional research is necessary to determine the maximum incudostapedial defect length suitable for bone cement repair.