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 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.

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.

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.)

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.

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.

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.

Ossicular chain reconstruction: endoscopic or microscopic?

2021 ◽  
pp. 1-7
Author(s):  
E A Guneri ◽  
A Cakir Cetin
Keyword(s):  
Word Recognition ◽  
Middle Ear ◽  
Risk Index ◽  
Ossicular Chain ◽  
Recognition Score ◽  
Reconstruction Surgery ◽  
Ossicular Chain Reconstruction ◽  
Operation Duration ◽  
Air Conduction

Abstract Objective To compare the results of endoscopic and microscopic ossicular chain reconstruction surgery. Methods Patients undergoing ossicular chain reconstruction surgery via an endoscopic (n = 31) or microscopic (n = 34) technique were analysed for age, gender, Middle Ear Risk Index, ossicular chain defect, incision type, ossicular chain reconstruction surgery material, mean air conduction threshold, air–bone gap, air–bone gap gain, word recognition score, mean operation duration and mean post-operative follow up. Results Post-operative air conduction, air–bone gap and word recognition score improved significantly in both groups (within-subject p < 0.001 for air conduction and air–bone gap, and 0.026 for word recognition score); differences between groups were not significant (between-subject p = 0.192 for air conduction, 0.102 for air–bone gap, and 0.709 for word recognition score). Other parameters were similar between groups, except for incision type. However, endoscopic ossicular chain reconstruction surgery was associated with a significantly shorter operation duration (p < 0.001). Conclusion Endoscopic ossicular chain reconstruction surgery can achieve comparable surgical and audiological outcomes to those of microscopic ossicular chain reconstruction surgery in a shorter time.

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.

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

2019 ◽  
Vol 161 (1) ◽  
pp. 123-129 ◽  
Author(s):  
C. Burton Wood ◽  
Robert Yawn ◽  
Anne Sun Lowery ◽  
Brendan P. O’Connell ◽  
David Haynes ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Ossicular Chain ◽  
Tertiary Care Center ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Hearing Outcomes

Objective(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.Study DesignCase series with chart review.SettingTertiary care center.Subject and MethodsThis study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.ResultsIn total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).ConclusionTitanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

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