Combination of Direct Oval Window Vibroplasty With Customized Partial Ossicular Replacement Prosthesis (PORP)

Objective: To compare audiometric results between the standard total ossicular replacement prosthesis (TORP-S) and a new fat interposition total ossicular replacement prosthesis (TORP-F) in pediatric and adult patients and to assess the complication and the undesirable outcome. Study design: This is a retrospective study. Methods: This study included 104 patients who had undergone titanium implants with TORP-F and 54 patients who had undergone the procedure with TORP-S between 2008 and 2013 in our tertiary care centers. The new technique consists of interposing a fat graft between the 4 legs of the universal titanium prosthesis (Medtronic Xomed Inc, Jacksonville, FL, USA) to provide a more stable TORP in the ovale window niche. Normally, this prosthesis is designed to fit on the stapes’ head as a partial ossicular replacement prosthesis. Results: The postoperative air-bone gap less than 25 dB for the combined cohort was 69.2% and 41.7% for the TORP-F and the TORP-S groups, respectively. The mean follow-up was 17 months postoperatively. By stratifying data, the pediatric cohort shows 56.5% in the TORP-F group (n = 52) compared with 40% in the TORP-S group (n = 29). However, the adult cohort shows 79.3% in the TORP-F group (n = 52) compared with 43.75% in the TORP-S group (n = 25). These improvements in hearing were statistically significant. There were no statistically significant differences in the speech discrimination scores. The only undesirable outcome that was statistically different between the 2 groups was the prosthesis displacement: 7% in the TORP-F group compared with 19% in the TORP-S group ( P = .03). Conclusions: The interposition of a fat graft between the legs of the titanium implants (TORP-F) provides superior hearing results compared with a standard procedure (TORP-S) in pediatric and adult populations because of its better stability in the oval window niche.

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Cartilage ‘shoe’: a new technique for stabilisation of titanium total ossicular replacement prosthesis at centre of stapes footplate

The Journal of Laryngology & Otology ◽

10.1017/s0022215108002545 ◽

2008 ◽

Vol 122 (7) ◽

pp. 682-686 ◽

Cited By ~ 27

Author(s):

D Beutner ◽

J C Luers ◽

K B Huttenbrink

Keyword(s):

Ossicular Chain ◽

Oval Window ◽

Central Hole ◽

New Technique ◽

Hearing Results ◽

Ossicular Replacement ◽

Stapes Footplate ◽

Ossicular Chain Reconstruction ◽

A New Technique ◽

Replacement Prosthesis

AbstractObjectives:After tympanoplasty using a total ossicular replacement prosthesis, many unsatisfactory hearing results are due to dislocation of the prosthesis.Material and methods:We developed a cartilage guide for stabilising the total ossicular replacement prosthesis in the oval window niche. An oval-shaped piece of cartilage measuring 2.5 × 3.5 mm with a central hole was precisely punched out of a thin cartilage plate. The cartilage was placed in the oval niche, and its hole centred the prosthesis on the stapes footplate.Results:Hearing results in 52 patients confirmed acoustically the effectiveness of this method of total ossicular replacement prosthesis stabilisation on the stapes footplate. Subsequent ‘second-look’ surgery revealed stable ingrowth of the cartilage ‘shoe’ into the oval niche.Conclusion:Such a cartilage shoe might address one of the causes of unsatisfactory hearing following ossicular chain reconstruction with a total ossicular replacement prosthesis.

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Polyethylene Sponge Total Ossicular Replacement Prosthesis: A Histopathologic Study-Reply

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1984.00800370067020 ◽

1984 ◽

Vol 110 (11) ◽

pp. 765-765

Author(s):

J. J. SHEA

Keyword(s):

Histopathologic Study ◽

Ossicular Replacement ◽

Replacement Prosthesis

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Soft tissue reaction to ceramic ossicular replacement prosthesis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100102944 ◽

1987 ◽

Vol 101 (9) ◽

pp. 897-904 ◽

Cited By ~ 4

Author(s):

Etsuo Yamamoto ◽

Michitaka Iwanaga

Keyword(s):

Soft Tissue ◽

Connective Tissue ◽

Inflammatory Cell ◽

Clinical Results ◽

Tissue Reaction ◽

Fibrous Connective Tissue ◽

Soft Tissue Reaction ◽

Fascia Graft ◽

Ossicular Replacement ◽

Replacement Prosthesis

AbstractSoft-tissue reaction to ceramic ossicular replacement prostheses (CORP) has been evaluated histologically in rabbits and humans. One week after implantation, severe inflammatory and foreign body reaction was observed in the fibrous connective tissue surrounding the prosthesis. Though some inflammatory response was seen after one month, after three months the CORP was surrounded by a layer of fibrous connective tissue without any foreigh body giant cell, histiocyte or inflammatory cell infiltration. Our satisfactory clinical results in humans without placing a cartilage between the CORP and the fascia graft may be due to the excellent softtissue compatibility of CORP, as demonstrated in this study.

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Autologous total ossicular replacement prosthesis

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002679 ◽

2014 ◽

Vol 128 (12) ◽

pp. 1050-1055 ◽

Cited By ~ 5

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.

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