Displacement of a Total Ossicular Replacement Prosthesis Following Ossicular Chain Reconstruction

2020 ◽  
pp. 000348942095358
Author(s):  
Aparna Govindan ◽  
Rohini R. Bahethi ◽  
Zachary G. Schwam ◽  
George B. Wanna
Keyword(s):  
Symptom Severity ◽  
Rare Complication ◽  
Ossicular Chain ◽  
Tympanic Membrane Perforation ◽  
High Dose ◽  
Mild Improvement ◽  
Membrane Perforation ◽  
Ossicular Replacement ◽  
Ossicular Chain Reconstruction ◽  
Replacement Prosthesis

Objective: Herein we describe the diagnosis and management of total ossicular replacement prosthesis (TORP) displacement following tympanoplasty with ossicular chain reconstruction (OCR). Methods: Case report with literature review. Results/Case: A 40-year-old male with otorrhea and tympanic membrane perforation underwent a right revision tympanoplasty with OCR using a TORP with a tragal chondroperichondrial graft. On postoperative day (POD) 4, he developed vertigo and profound right-sided hearing loss. Temporal bone computed tomography showed the prosthesis in the vestibule. After a steroid taper with mild improvement in symptoms, the TORP was removed two weeks later and the patient continued to improve. Conclusion: TORP displacement into the vestibule is a very rare complication following OCR. Conservative management with high dose steroids may improve symptoms, however further middle ear exploration and surgical management may be warranted depending on the depth of displacement into the inner ear as well as symptom severity.

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.

Mediolateral Graft Tympanoplasty for Anterior or Subtotal Tympanic Membrane Perforation

2005 ◽  
Vol 132 (4) ◽  
pp. 532-536 ◽  
Author(s):  
Timothy T. K. Jung ◽  
Seong Kook Park
Keyword(s):  
Tympanic Membrane ◽  
Tertiary Care ◽  
Tympanic Membrane Perforation ◽  
Hearing Improvement ◽  
Anterior Half ◽  
Fascia Graft ◽  
Membrane Perforation ◽  
Ossicular Replacement ◽  
Tertiary Care Centers ◽  
Replacement Prosthesis

OBJECTIVE: To describe and evaluate the mediolateral graft tympanoplasty for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation. STUDY DESIGN AND SETTING: Retrospective study of 100 patients who underwent the mediolateral graft tympanoplasty at community and tertiary care centers from 1995 to 2001. All patients underwent preoperative and postoperative audiograms. Posterior tympanomeatal flap is elevated same as in the medial (underlay) graft tympanoplasty. Anterior-medial canal skin is elevated down to the annulus. At the annulus, only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial (underlay) to the posterior half of the perforation and lateral (overlay) to the anterior half of the de-epithelialized TM perforation, up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second-layer closure. Patients were followed for at least 6 months. Outcome was considered successful if the TM is intact. RESULTS: There were 3 failures (97% success rate), attributable to a postoperative infection, anterior blunting, and recurrent cholesteatoma, respectively. There was no significant postoperative hearing loss compared with preoperative hearing. More than 70% of the operated ears had hearing improvement of 0-40 dB (0-10 dB in 19% of ears, 11-20 dB in 44%, 21-30 dB in 7%, and 31-40 dB in 4%) even without ossiculoplasty. With ossiculoplasty using either partial ossicular replacement prosthesis (PORP, 15%) or total ossicular replacement prosthesis (TORP, 11%), there were various degree of hearing improvement from 11 to 30 dB. CONCLUSION AND SIGNIFICANCE: The mediolateral graft method is superior to the traditional medial or lateral graft technique for the reconstruction of large anterior or subtotal TM perforation. This new method should help otologic surgeons to improve outcome of tympanoplasty for anterior or total TM perforation. EBM rating: C-1.

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

2008 ◽  
Vol 122 (7) ◽  
pp. 682-686 ◽  
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.

Middle-ear reconstruction: a review of 150 cases

2002 ◽  
Vol 116 (6) ◽  
pp. 435-439 ◽  
Author(s):  
Ikramullah Khan ◽  
Amir M. Jan ◽  
Farrukh Shahzad
Keyword(s):  
Success Rate ◽  
Tympanic Membrane ◽  
Ossicular Chain ◽  
Tympanic Membrane Perforation ◽  
Ear Reconstruction ◽  
Membrane Perforation ◽  
Ossicular Chain Reconstruction ◽  
Post Operation ◽  
One Year ◽  
Intact Tympanic Membrane

This study is based on a retrospective analysis of 150 cases of tympanoplasty and ossicular chain reconstruction as a one-stage procedure. It was conducted at the Federal Government Services Hospital, Islamabad from 1983 to 1999. Temporalis fascia was used for myringoplasty and a sculptured autologous incus to bridge the malleus to stapes head and malleus to footplate gap. These interpositions have produced stable ossicular assemblies and provided satisfactory post-operative hearing gains. One hundred and twenty-six (84 per cent) patients achieved a healed tympanic membrane three months post-operatively. One year post-operatively, 121 (81 per cent) patients had an intact tympanic membrane and at five years 119 (79 per cent) had an intact tympanic membrane. The success rate was based on an intact tympanic membrane and an air-bone gapof less than 30 dB one-year post-operation. Accordingly, the overall success rate was 80 per cent (120 cases). Hearing gains in cases with an absent stapes arch were poorer than in cases with an intact arch. Early (one to three months) post-operative complications included tympanic membrane perforation, lateralization of the graft and persistence of infection. Late (one to five years) complications included the appearance of an anterior perforation and retraction and thinning of the tympanic membrane.

scholarly journals Comparison of the Hearing Results of Total Ossicular Chain Autogenous Mastoid Cortical Bone Ossiculoplasty and Titanium Total Ossicular Replacement Prosthesis in Patients with Cholesteatoma

2020 ◽  
Keyword(s):  
Cortical Bone ◽  
Risk Index ◽  
Ossicular Chain ◽  
Hearing Results ◽  
Significant Difference ◽  
Ossicular Replacement ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Group D ◽  
Replacement Prosthesis

Background: No studies have investigated the results of ossicular chain reconstruction using mastoid cortical bone ossiculoplasty (MCBO) and titanium total ossicular replacement prosthesis (TiTORP) in Austin-Kartush Group D cholesteatoma patients with severe middle ear risk index (MERI). Objectives: The present study aimed to compare the hearing results of MCBO and TiTORP in Austin-Kartush Group D cholesteatoma patients with severe MERI who underwent ossicular chain reconstruction during primary surgery. Methods: The hearing results of 28 adult cholesteatoma patients who underwent tympanomastoidectomy and ossicular chain reconstruction with MCBO (n=15) or TiTORP (n=13) were analyzed in the current study. The postoperative hearing was tested 12 months after the surgery. The hearing-related functional success rate was determined in accordance with the American Academy of Otolaryngology-Head and Neck Surgery Foundation criteria. Results: When all patients were taken into account, the mean preoperative and postoperative air-bone gaps (ABG) were reported as 32.2 decibel (dB) and 17.6 dB, respectively, (P<0.001). In 57.1% of the patients, the mean postoperative ABG was ≤ 20 dB. The mean preoperative and postoperative ABGs of the MCBO group were obtained at 29.9 and 16.2 dB, while these values were reported as 35.0 and 19.3 dB in the TiTORP group (P=0.001 and P<0.001, respectively). Hearing-related functional success rates were calculated at 60.0% and 53.8% in MCBO and TiTORP groups, respectively, without any significant difference between the groups (P= 0.743). Conclusion: As evidenced by the obtained results, MCBO and TiTORP can provide similar and successful hearing results in Austin-Kartush Group D patients with cholesteatoma; nonetheless, MCBO is a more cost-effective option in this regard.

scholarly journals Closure of small perforation in tympanic membrane by use of fat plug

2020 ◽  
Vol 6 (9) ◽  
pp. 1647
Author(s):  
Nehal R. Patel ◽  
Vaibhav V. Patel ◽  
Dimpal Padavi ◽  
Mayur Prajapati ◽  
Rachana M. Khokhani ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Ossicular Chain ◽  
Tympanic Membrane Perforation ◽  
Major Surgery ◽  
Graft Material ◽  
Middle Ear Mucosa ◽  
Suppurative Otitis Media ◽  
Membrane Perforation ◽  
Conventional Myringoplasty ◽  
Small Perforation

<p class="abstract"><strong>Background: </strong>Chronic suppurative otitis media presents mostly with ear discharge and associated decreased hearing. Tympanoplasty is the established surgery for tympanic membrane perforation. Most commonly used graft material for tympanoplasty is temporalis fascia. Others are fascia lata, tragal perichondrium, tragal cartilage, fat. The objective of the study was to compare the graft taken up and hearing improvement following myringoplasty with use of fat.</p><p class="abstract"><strong>Methods:</strong> Patients of CSOM aged 10 to 65 years old with small central perforation which is dry for at least 3 weeks with normal middle ear mucosa and intact ossicular chain with mild conductive hearing loss. The present study was carried out in Ear, neck and throat (ENT) Department of SCL hospital, Ahmedabad from July 2016 till September 2018 and 25 patients were randomly selected fulfilling the above criteria.</p><p class="abstract"><strong>Result: </strong>The choice of graft affects not only the outcome of surgery, but also determines the complexity of the procedure and the time taken for the same. Study proves that fat is also a one of the good grafting material which is easily available and keep to prevent from major surgery. The results have been quite encouraging.</p><p class="abstract"><strong>Conclusion: </strong>Study proves that fat is also a one of the good grafting material which is easily available and keep to prevent from major surgery. An added advantage of this technique was the excellent post-operative quality of life of the operated patients, assessed in terms of the chronic ear survey and evident by the absence of the usual post-operative complaints following a conventional myringoplasty.</p>

Use of Mimix hydroxyapatite bone cement for difficult ossicular reconstruction

2005 ◽  
Vol 132 (5) ◽  
pp. 727-734 ◽  
Author(s):  
Joel A. Goebel ◽  
Abraham Jacob
Keyword(s):  
Bone Cement ◽  
Medical Center ◽  
Case Series ◽  
Ossicular Chain ◽  
Successful Outcome ◽  
Speech Reception ◽  
Ossicular Replacement ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Speech Reception Thresholds

OBJECTIVE: To describe the advantages of using MimixTM hydroxyapatite (HA) bone cement in reconstructing a variety of ossicular chain abnormalities. STUDY DESIGN AND SETTING: Case series at a tertiary medical center. RESULTS: Twenty-five cases of HA reconstruction are included in this series (ages 23-74; mean, 47 years). The examples presented include (1) HA as the sole reconstructive material for incus erosion, (2) HA for securing a total or partial ossicular replacement prosthesis, (3) incus augmentation after crimping for revision stapedotomy with incus erosion, (4) HA in primary stapedotomy to fix the crimped prosthesis to an intact incus, and (5) other unique situations. Preoperative and postoperative audiograms were evaluated for 4-tone pure tone average (PTA), speech reception thresholds, word recognition scores, and air-bone gaps (AB gaps). Mean follow-up was 11 months (range 2 to 22 months). The mean PTA improved from 57 dB to 37 dB, whereas the mean AB gaps decreased from 33 dB to 16 dB. There were no cases of infection or extrusion. CONCLUSIONS: Hydroxyapatite bone cement is an excellent adjunct or alternative to ossiculoplasty with preformed prostheses. Easily malleable, rapidly setting, and rapidly hardening, Mimix is particularly well suited for middle ear work. SIGNIFICANCE: Definitive fixation with bone cements during difficult ossicular chain reconstruction may ensure a more enduring successful outcome. (Otolaryngol Head Neck Surg 2005; 132:727-34.)

Allograft Tympanoplasty Type 1 in the Childhood Population

1996 ◽  
Vol 105 (11) ◽  
pp. 871-876 ◽  
Author(s):  
Evert P. P. M. Hamans ◽  
Thomas Somers ◽  
Paul J. Govaerts ◽  
F. Erwin Offeciers
Keyword(s):  
Functional Results ◽  
Ossicular Chain ◽  
Statistical Correlation ◽  
Tympanic Membrane Perforation ◽  
Short Term ◽  
Membrane Perforation ◽  
Childhood Population

Seventy allograft type 1 tympanoplasties in children under 16 years of age were studied retrospectively. Only patients with a tympanic membrane perforation without cholesteatoma and a normal ossicular chain were included. Short-term and long-term anatomic and functional results were analyzed after a mean follow-up of 40 months. The overall short-term take rate was 97% and the long-term take rate was 88%. A number of variables with alleged prognostic value for surgical outcome were analyzed, but none showed statistical correlation with either anatomic or functional results. A median hearing gain of 10 dB was achieved, which was stable over time. We conclude that allograft tympanoplasty type 1 in this group of children is anatomically and functionally successful regardless of age.

scholarly journals Hydroxyapatite Prostheses in Endoscopic Transcanal Stapes Surgery for Otosclerosis Cases

2021 ◽  
pp. 014556132198914
Author(s):  
Makoto Hosoya ◽  
Masato Fujioka ◽  
Kaoru Ogawa
Keyword(s):  
Facial Nerve Palsy ◽  
Case Series ◽  
Ossicular Chain ◽  
Tympanic Membrane Perforation ◽  
Stapes Surgery ◽  
Chorda Tympani ◽  
Postoperative Results ◽  
Ear Surgery ◽  
Intraoperative Complication ◽  
Membrane Perforation

Objectives: Hydroxyapatite is a commonly used material for medical applications due to its excellent biocompatibility. We use hydroxyapatite prosthesis for the reconstruction of the ossicular chain in stapes surgery. In this study, we report a case series of endoscopic ear surgery using a basket-type hydroxyapatite prosthesis. Methods: We retrospectively examined 8 cases of endoscopic transcanal stapes surgery using hydroxyapatite prostheses. We evaluated the postoperative results and complications. Results: The average postoperative air–bone gaps were within 10 dB in all cases. Postoperative sensorineural hearing loss was not observed in any case. There was an intraoperative complication with the chorda tympani in 1 patient. We were able to preserve the chorda tympani of all patients, including this case. Postoperative transient dizziness and transient taste disorder were observed in 50% of cases. No other complications, including facial nerve palsy, tympanic membrane perforation, or postoperative infection, were observed. Conclusions: The postoperative results and complications were comparable to those of surgery under a microscope. The hydroxyapatite prosthesis could be a possible alternative for the piston-type titanium or polytetrafluoroethylene prosthesis.

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