Comparison of Autologous Malleus Head and Hydroxyapatite Partial Replacement Prosthesis in Ossicular Chain Reconstruction

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.

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Displacement of a Total Ossicular Replacement Prosthesis Following Ossicular Chain Reconstruction

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420953587 ◽

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.

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

10.32592/ircmj.2021.23.1.220 ◽

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.

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Ossicular chain reconstruction: endoscopic or microscopic?

The Journal of Laryngology & Otology ◽

10.1017/s0022215120002728 ◽

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.

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Ossicular Discontinuity and Exostoses in Proteus Syndrome: A Case Report

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940511400314 ◽

2005 ◽

Vol 114 (3) ◽

pp. 242-246

Author(s):

Joni K. Doherty ◽

Dennis R. Maceri

Keyword(s):

Hearing Loss ◽

High Frequency ◽

Conductive Hearing Loss ◽

Ossicular Chain ◽

Typical Feature ◽

Proteus Syndrome ◽

Frequency Range ◽

Pure Tone Average ◽

Ossicular Chain Reconstruction ◽

Conductive Hearing

Proteus syndrome (PS) is a rare hamartomatous disorder characterized by mosaic overgrowth of multiple tissues that manifests early in life and is progressive. The presence of unilateral external auditory canal exostoses in a patient who is not a swimmer or surfer is suggestive of PS. However, hearing loss is not a typical feature. Here, we describe exostoses and ossicular discontinuity with conductive hearing loss in a patient with PS. The treatment consisted of canalplasty and ossicular chain reconstruction. A postoperative reduction was demonstrated in the patient's air-bone gap, from 21 dB to 13 dB for the pure tone average (four frequencies) and from 41 dB to 15 dB in the high-frequency range (6,000 to 8,000 Hz). Causes of ossicular discontinuity are discussed. Routine annual audiometric and otolaryngological evaluation should be considered in all patients with temporal bone inyolvement of PS.

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Ossicular Chain Reconstruction in a Developing Country

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418760054 ◽

2018 ◽

Vol 127 (5) ◽

pp. 306-311 ◽

Cited By ~ 3

Author(s):

Es-Hak Bedri ◽

Miriam Redleaf

Keyword(s):

Tympanic Membrane ◽

Developing Country ◽

Middle Ear ◽

Granulation Tissue ◽

Ossicular Chain ◽

Single Stage ◽

Limited Resources ◽

Closure Rate ◽

Average Improvement ◽

Ossicular Chain Reconstruction

Objectives: In Ethiopia, 2-stage operations with middle ear prostheses are economically unfavorable. We hypothesized that single-stage autologous ossiculoplasty results in acceptable tympanic membrane (TM) and hearing improvements in a setting of limited resources. Methods: One hundred eighty-eight patients (197 ears) who underwent 1-stage autologous ossiculoplasty for ossicular dysfunction are presented. All but 14 of these ears also had perforations of the TM. Conditions of the middle ear were granulation tissue, ossicular disruption only, tympanosclerosis, and cholesteatoma. Reconstructions of the ossicular chain were performed with autologous ossicles only. Results: The closure rate of TM perforations was 95%. Preoperative air bone gaps were 27 to 60 dB (mean [SD] = 44 [7] dB); postoperative air bone gaps were 0 to 50 dB (average [SD] = 23 [10] dB), for an average improvement of 21 dB across all reconstruction types ( P < .001). The largest favorable changes in air bone gaps were with incus and malleus columellas from the footplate to the TM (33 and 23 dB, respectively) ( P < .001). No patient had worsening of sensorineural hearing levels or extrusion of the reconstructed ossicles. Conclusion: Autologous ossiculoplasty performed well in this setting. Acceptable TM closure rates and improvement of air bone gaps were seen in 1-stage operations without the use of prostheses.

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