Outcomes with gold wire and hydroxyapatite partial ossicular replacement prostheses in type 2 tympanoplasty: a preliminary study

2015 ◽  
Vol 129 (2) ◽  
pp. 142-147 ◽  
Author(s):  
H Katilmis ◽  
M Songu ◽  
H Aslan ◽  
Y Ozkul ◽  
S Basoglu ◽  
...  
Keyword(s):  
Bone Conduction ◽  
Chronic Otitis Media ◽  
Gold Wire ◽  
Complication Rates ◽  
Graft Take ◽  
Ossicular Replacement ◽  
The Mean ◽  
One Year ◽  
Replacement Prosthesis

AbstractObjectives:To compare the hearing results and graft take rates of the recently developed gold wire prosthesis with those of the hydroxyapatite partial ossicular replacement prosthesis in patients with chronic otitis media.Method:This retrospective study examined patients who underwent type 2 tympanoplasty with a minimum follow up of one year. The study population consisted of 32 patients in the partial ossicular replacement prosthesis group and 26 patients in the gold wire group. The main outcome measures were the graft success rate and level of hearing improvement. Complications and extrusion rates were also noted.Results:The graft take rate was 90.6 per cent for the partial ossicular replacement prosthesis group and 92.3 per cent for the gold wire group (p = 0.848). Pre-operatively, there were no significant differences in the air or bone-conduction thresholds between groups. Post-operatively, the mean hearing gain was 18.5 ± 14.0 dB in the partial ossicular replacement prosthesis group and 16.5 ± 10.6 dB in the gold wire group (p = 0.555). The mean air-conduction thresholds were 26.6 ± 12.4 and 32.6 ± 10.5 dB, respectively (p = 0.027), and the mean bone-conduction thresholds were 9.7 ± 7.0 and 10.4 ± 6.4 dB, respectively (p = 0.687).Conclusion:The success and complication rates provided by the gold wire prosthesis seem comparable to those of the hydroxyapatite partial ossicular replacement prosthesis.

scholarly journals Endoscopic Ossiculoplasty for the Management of Isolated Congenital Ossicular Chain Malformation: Surgical Results in 16 Ears

2020 ◽  
pp. 014556132093121
Author(s):  
Chunlin Zhang ◽  
Jiaoping Mi ◽  
Dan Long ◽  
Yuan Deng ◽  
Qiang Sun ◽  
...  
Keyword(s):  
Bone Conduction ◽  
Ossicular Chain ◽  
Chorda Tympani ◽  
Chorda Tympani Nerve ◽  
Hearing Outcome ◽  
Before And After ◽  
Ossicular Replacement ◽  
The Mean ◽  
Replacement Prosthesis ◽  
Air Conduction

Objective: The aim of this study is to describe the clinical characteristics and intraoperative findings and further evaluate the efficacy of endoscopic ossiculoplasty for the management of isolated congenital ossicular chain malformation. Methods: A retrospective study was performed on 16 ears (15 patients) with the isolated congenital ossicular chain malformation who underwent endoscopic ossiculoplasty in our department from May 2017 to January 2019. Endoscopic exploratory tympanotomy was conducted to check the ossicular chain; at the same time, endoscopic ossiculoplasty was performed depending on intraoperative findings. Air-conduction thresholds, bone-conduction thresholds, and air-bone gaps (ABGs) were measured before and after surgery, and the hearing outcome was assessed at 6 months postoperatively. Results: The most common malformations of ossicular chain were the missing of the incus long process and stapes suprastructure. A serial assessment of the hearing status was conducted before and 6 months after surgery. It showed the mean postoperative pure-tone average (PTA) was significantly reduced, and the mean postoperative ABG was obviously closed, respectively ( P < .001). The mean PTA gain was 36.3 ± 8.6 dB, and the ABG closure was 35.1 ± 8.3 dB; ABG closure to 20 dB or less and ABG closure to 10 dB or less were achieved in 14 cases (87.5%) and 5 cases (31.3%), respectively. No differences were observed in postoperative hearing outcome between type Ⅲ cases and type Ⅳ cases; however, cases with partial ossicular replacement prosthesis implantation showed a larger hearing gain ( P = .049) and a higher proportion of postoperative ABG less than 10 dB ( P = .021). No facial palsy and significant sensorineural hearing loss occurred; all patients completed the surgery without the need of canalplasty, and the chorda tympani nerve was preserved in all patients. Conclusions: This research showed endoscopic surgery was effective in the diagnosis and management of isolated congenital ossicular chain malformation; the endoscopic ossiculoplasty provides an alternative method to manage congenital ossicular chain malformation, with comfortable hearing outcome and the advantage of excellent vision and less invasion.

Hearing Results with Clothespin Ossiculoplasty: Preliminary Report on the Kraus Modified Schuring Ossicle-Cup Prosthesis (Clothespin Prosthesis)

1993 ◽  
Vol 109 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Eric M. Kraus
Keyword(s):  
Joint Stability ◽  
Hearing Results ◽  
Inferior Surface ◽  
Ossicular Replacement ◽  
The Mean ◽  
Mortise And Tenon ◽  
One Year ◽  
Flexible Disk ◽  
Replacement Prosthesis ◽  
Made In

The clothespin partial ossicular replacement prosthesis (PORP) is designed to Increase Joint stability during incus replacement ossiculoplasty. Fundamental modifications have been made in the Schuring ossicle-cup, which include a forked well, increased well wall thickness and length, and a flexible tip disk added to the shaft. The forked well functions like a straight clothespin rather than an inverted cup. The forked well enables the clothespin prothesis to slide down over the stapes superstructure, between the facial nerve canal and the promontory, to form a stable, mortise-and-tenon prosthesis-stapedial joint. Joint stability is enhanced because the inferior tine of the forked well is able to lever against the inferior surface of the stapes superstructure, creating a counterforce to gravity. This is in contrast to the more unstable ball-and-socket joint created by most partial ossicular replacement prostheses when they articulate with the stapes capitulum. The addition of a flexible disk to the shaft tip produces a tight, stable union between the prosthesis and the ossicular cap by increasing resistance at the shaft-ossicle interface. Fluoroplastic composition maximizes Intraoperative versatility and reliability while the ossicle cap minimizes extrusions. One-year hearing results for twelve chronic ear patients with mobile stapes undergoing clothespin ossiculoplasty during intact canal wall tympanomastoidectomy revealed postoperative air-bone gaps within 20 dB in 92% of cases. The mean postoperative air-bone gap was 8.9 dB, and the mean Improvement in air-bone gap was 14.4 dB. These results are attributable to greater prosthesis stability provided by the time-tested mortise-and-tenon joint concept rather than a ball-and-socket joint in a reconstructive situation in which stability is critical.

scholarly journals The use of total ossicular replacement prosthesis after radical tympanomastoidectomy

2013 ◽  
Vol 70 (5) ◽  
pp. 463-468
Author(s):  
Dejan Rancic
Keyword(s):  
Hearing Aids ◽  
Bone Conduction ◽  
Second Step ◽  
Second Stage ◽  
Hearing Recovery ◽  
Ossicular Replacement ◽  
One Year ◽  
Replacement Prosthesis ◽  
Air Conduction

Background/Aim. This paper presents our operative method for hearing recovery after the previous radical tympanomastoidectomy, radical trepanation of the temporal bone (trepanatio radicalis ossis temporalis - TROT) in eight patients submitted to operations for giant cholesteatotoma. Methods. All the patients were admitted to our clinic after TROT. There were no signs of cholesteatoma or infection. The patients refused any stent implantations or any hearing aids due to possible aesthetic problems. The described procedure developed in two steps. The first one was to restore the destroyed cavum tympany and to covert with chondroperichondral new membrane with a pin-like ?guide? as collumela. The second step was to insert a TORP (total ossicular replacement prosthesis) after guide excision. Results. After the first operation (stage one) there were no infections in the operated area nor chondroperichondral graft rejection. Postoperative audiometry (6 to 8 weeks) was done to demonstrate the improvement of air conduction. Three months following the first, the second (stage two) operation was performed and 2.5 to 3 months after this operation even greater audiometry revealed hearing improvement in air- and bone-conduction. The patients were dismissed from the hospital 2 days after each procedure without any complications. They did not experience any dizziness, vomiting nor a severe pain. Three months after the second operative stage, otoscopic findings were very good. The audiometry findings after a 3-months period (after stage one) and 3 months after final TORP insertion was done for each of the patients. After one year, the audiometric curve was the same. Clinical and audiometry follow up demonstrated a hearing recovery and closure of air bone gap (ABG) to values of 5 to 15 dB. Conclusion. The use of TORP after radical tympanomastoidectomy is feasible. The first step of the procedure is the fixation of a neomembrane. A stabilized neomembrane is essential for light overpressure on the prosthesis and this is important for optimal or better conductivity. A better hearing recovery is confirmed with audiometric findings and ABG reduction to 5-15 dB. This method could be performed in all patients (with good boneconduction) after radical tympanomastoidectomy for better hearing.

Frequency-Specific Analysis of Hearing Outcomes Associated with Ossiculoplasty Versus Stapedotomy

2021 ◽  
pp. 000348942199016
Author(s):  
Denis D. Nguyen ◽  
Ryan T. Judd ◽  
Terence E. Imbery ◽  
Michael B. Gluth
Keyword(s):  
Bone Conduction ◽  
Retrospective Chart Review ◽  
Ossicular Chain ◽  
Specific Analysis ◽  
Mass Load ◽  
Ossicular Replacement ◽  
The Mean ◽  
Hearing Outcomes ◽  
Replacement Prosthesis

Objective: Surgery on the ossicular chain may impact its underlying mechanical properties. This study aims to investigate comparative differences in frequency-specific hearing outcomes for ossiculoplasty versus stapedotomy. Methods: A retrospective chart review was conducted on subjects who underwent ossiculoplasty with partial ossicular replacement prosthesis (PORP) or laser stapedotomy with self-crimping nitinol/fluoroplastic piston, and achieved closure of postoperative pure tone average air-bone gap (PTA-ABG) ≤ 15 dB. 45 PORP and 38 stapedotomy cases were included, with mean length of follow-up of 7.6 months. Results: The mean change in PTA-ABG was similar for the 2 procedures (−17.9 dB vs −18.1 dB, P = .98). Postoperative ABG closure for stapedotomy was superior at 1000 Hz (8.9 dB vs 13.9 dB, P = .0003) and 4000 Hz (11.8 dB vs 18.0 dB, P = .0073). Both procedures also had improved postoperative bone conduction (BC) thresholds at nearly all frequencies, but there was no statistical difference in the change in BC at any particular frequency between the 2 procedures. Conclusion: Both procedures achieved a similar mean change in PTA-ABG. Stapedotomy was superior to PORP at ABG closure at 1000 Hz and at 4000 Hz, with 1000 Hz the most discrepant. The exact mechanism responsible for these changes is unclear, but the specific frequencies affected suggest that differences in each procedure’s respective impact on the native resonant frequency and mass load of the system could be implicated.

Autologous total ossicular replacement prosthesis

2014 ◽  
Vol 128 (12) ◽  
pp. 1050-1055 ◽  
Author(s):  
M Malhotra ◽  
S Varshney ◽  
R Malhotra
Keyword(s):  
Pure Tone ◽  
Chronic Otitis Media ◽  
Canal Wall ◽  
Hearing Improvement ◽  
Hearing Results ◽  
Replacement Technique ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
Replacement Prosthesis ◽  
Air Conduction

AbstractObjective:To develop an autologous total ossicular replacement prosthesis with sustainable hearing results.Methods:The ears of 40 patients, who had chronic otitis media with absent suprastructure of the stapes and long process of the incus, were repaired using the autologous total ossicular replacement technique. Post-operative results were evaluated after 6 and 12 months on the basis of average pure tone air conduction and average air–bone gap measured at 0.5, 1, 2 and 3 kHz.Results:Successful rehabilitation of pure tone average to 30 dB or less was achieved in 75 per cent of patients, and air–bone gap to 20 dB or less was attained in 82.5 per cent of patients. Overall mean improvement in air–bone gap was 23.9 ± 8.5 dB (p < 0.001). Mean improvements in air–bone gap were significantly greater (p < 0.05) in the tympanoplasty only group (27.3 ± 6.6 dB) and the intact canal wall tympanoplasty group (25.9 ± 6.3 dB) than in the canal wall down tympanoplasty group (16.3 ± 8.9 dB).Conclusion:This paper describes an autologous total ossicular replacement prosthesis that is biocompatible, stable, magnetic resonance imaging compatible and, above all, results in sustainable hearing improvement.

The styloid process in ossicular chain reconstruction

1988 ◽  
Vol 102 (2) ◽  
pp. 136-137 ◽  
Author(s):  
S. B. Ogale ◽  
C. Desouza ◽  
J. Sheode ◽  
K. L. Shah
Keyword(s):  
Bone Conduction ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Styloid Process ◽  
Long Term Results ◽  
Graft Material ◽  
Ossicular Chain Reconstruction ◽  
One Year

AbstractOur pilot study reports twenty-six cases of resolved chronic otitis media in which the human, cadaveric styloid process was used as an ossicular graft material. A maximum follow-up of one year is presented in this paper. There was no extrusion or rejection of the styloid processes. Hearing improvement with a closure of the air-bone gap to within 10–15 dB. of the pre-operative bone conduction was found in most cases. So far the styloid process has proved to be an ideal ossicular graft though the long-term results are yet to be seen.

Atypical incus necrosis: a case report and literature review

2007 ◽  
Vol 122 (10) ◽  
pp. 1124-1126 ◽  
Author(s):  
N Choudhury ◽  
G Kumar ◽  
M Krishnan ◽  
D J Gatland
Keyword(s):  
Case Report ◽  
Otitis Media ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Conductive Deafness ◽  
Ossicular Replacement ◽  
Stapes Footplate ◽  
History Of ◽  
Serous Otitis Media ◽  
Replacement Prosthesis

AbstractObjective:We report an atypical case of ossicular necrosis affecting the incus, in the absence of any history of chronic serous otitis media. We also discuss the current theories of incus necrosis.Case report:A male patient presented with a history of right unilateral hearing loss and tinnitus. Audiometry confirmed right conductive deafness; tympanometry was normal bilaterally. He underwent a right exploratory tympanotomy, which revealed atypical erosion of the proximal long process of the incus. Middle-ear examination was otherwise normal, with a mobile stapes footplate. The redundant long process of the incus was excised and a partial ossicular replacement prosthesis was inserted, resulting in improved hearing.Conclusion:Ossicular pathologies most commonly affect the incus. The commonest defect is an absent lenticular and distal long process of the incus, which is most commonly associated with chronic otitis media. This is the first reported case of ossicular necrosis, particularly of the proximal long process of the incus, in the absence of chronic middle-ear pathology.

Insertion of middle-ear Silastic sheeting during tympanoplasty: hearing outcomes

2010 ◽  
Vol 125 (5) ◽  
pp. 445-448 ◽  
Author(s):  
S M Elmorsy ◽  
H E Amer
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Chronic Inflammation ◽  
Middle Ear ◽  
Bone Conduction ◽  
Chronic Otitis Media ◽  
One Year ◽  
Operative Findings ◽  
Hearing Outcomes ◽  
Air Conduction

AbstractObjective:To study the effect of Silastic®sheeting placed in the middle ear during tympanoplasty, including the effect on hearing.Design:Retrospective study.Background:Chronic inflammation of the middle ear is common. Surgical treatment sometimes results in middle-ear adhesions and hearing deterioration.Materials and methods:We selected 106 patients with chronic otitis media, middle-ear adhesions and intact ossicles, based on intra-operative findings. These patients underwent single-stage tympanoplasty either with or without insertion of Silastic sheeting. Audiometry was undertaken pre-operatively and one and 12 months post-operatively.Results:Patients who had undergone Silastic sheet insertion showed significantly better air conduction, bone conduction and air–bone gap averages one year post-operatively, compared with those who had not.

scholarly journals Ossiculoplasty using Autologous Reshaped Incus and Teflon PORP: A Comparative Study

2019 ◽  
Vol 27 (2) ◽  
pp. 129-134
Author(s):  
Ankit Choudhary ◽  
Sayan Hazra ◽  
Arindam Das ◽  
Aryabrata Dubey ◽  
Mridul Janweja ◽  
...  
Keyword(s):  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Care Hospital ◽  
Hearing Results ◽  
Extrusion Rate ◽  
Hearing Result ◽  
Ossicular Replacement ◽  
Ossicular Chain Reconstruction ◽  
Study Population ◽  
Replacement Prosthesis

Introduction Autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) are commonly used for ossicular chain reconstruction. The present study attempts to assess the post-operative outcome with these two prostheses. Materials and Methods  A Randomized prospective study was conducted in Tertiary referral care hospital to determine which material, among autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) gives better postoperative hearing result in Ossiculoplasty. Patients presenting at outpatients’ department with the clinical diagnosis of chronic otitis media with perforation or retraction. The study population consisted of a total of 50 patients. Ossiculoplasty with reshaped Incus or PORP was performed after Canal Wall Up mastoidectomy. Hearing results were measured by Air-Bone gap in PTA after 6 months of surgery. Results  Selecting the criteria <20 dB ABG as success when Stapes superstructure is present, Incus has 64.29% success rate, whereas PORP has 31.81% success. Extrusion rate of different prosthesis shows PORP has 18.18% extrusion whereas autologous Incus has lower (7.14%) extrusion rate. Conclusion  Among these two ossiculoplasty materials, autologous Incus gives better postoperative hearing gain and lower extrusion rate.

scholarly journals A Prospective Study of Efficacy of Small Fenestra Stapedotomy at a South Asian Center

2018 ◽  
Vol 01 (01) ◽  
pp. 011-017
Author(s):  
Laya Sriraam ◽  
Sunita Shukla ◽  
Ravi Ramalingam ◽  
K. Ramalingam
Keyword(s):  
Facial Nerve ◽  
Prospective Study ◽  
Local Anesthesia ◽  
Anatomical Variation ◽  
Bone Conduction ◽  
Complication Rates ◽  
Hearing Improvement ◽  
History Of ◽  
The Mean ◽  
A Prospective Study

Abstract Introduction The best surgical treatment for otosclerosis is stapedotomy. Various methods are used for creating fenestra, including manual pick, laser, and Skeeter drill. In India, despite several studies on the hearing outcomes of otosclerosis surgery, there exist few studies on small fenestra stapedotomy performed using a microdrill. Hence, we designed this study with the objectives of examining the demographic profile, hearing improvement after surgery, anatomical variations encountered at surgery, effect of microdrill use on bone conduction (BC), and postoperative complications of small fenestra stapedotomy. Methods A prospective study was conducted for 63 patients of otosclerosis. Stapedotomy was performed by the same surgeon on all patients by a transcanal approach under local anesthesia. Small fenestra stapedotomy was performed using Skeeter microdrill. The study proforma included sociodemographic profile, clinical history, examination, audiometry, surgical details, and postoperative findings. Descriptive statistics was used to analyze the data. Results Our study demonstrated a male preponderance (58.7%) over females (41.3%). Of the study population, 31.7% reported a family history of otosclerosis, whereas nine (14.28%) individuals had a history of measles. All four different types of footplates were identified. Most of them were either type 1 (52.4%) or 2 (34.9%). In most cases, the diameter was 0.4 mm (96.8%), a majority of the cases having either 4.25 (22.2%) or 4.5 mm (63.5%) long piston. After stapes surgery, the mean ABG reduced from 39.48 (±9.17) to 13.89 (±7.99) dB. The mean worsening in postoperative BC was only 3.035 dB. Use of microdrill caused only a slight and statistically insignificant decline in BC. Anatomical variation of a narrow oval window niche may require drilling of the bone. In practice, this drilling does not adversely affect the BC of the patient. Some facial nerve variation (partially overhanging facial nerve and exposed facial nerve) may be encountered, but it does not affect the facial nerve function or hearing improvement. On rare occasions, facial paresis may occur on the fifth to sixth postoperative day, even without facial nerve handling. This can be managed conservatively with oral steroids with favorable results. Taste alterations are seen even when the chorda handling is minimal. Complaints are most common in the first few weeks after surgery. Over a 6-month period, only 5% of the patients who underwent surgery were found to have altered taste sensation. Conclusion Microdrill-assisted small fenestra stapedotomy, performed under local anesthesia, with placement of a 0.4-mm Teflon piston for patients with otosclerosis produces excellent results. The complication rates are low, and the surgery has a positive impact on the patient's hearing.

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