Ossiculoplasty With Titanium Prostheses in Patients With Intact Stapes

Baker, Andrew B.; O’Connell, Brendan P.; Nguyen, Shaun A.; Lambert, Paul R.

doi:10.1097/mao.0000000000000893

Cited by 31 publications

(16 citation statements)

References 16 publications

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“…In our study, data on 27 patients are presented, and a mean improvement in ABG of 10.9 ± 13.5 dB was achieved. Our data are in agreement with another study in which TORP with an intact stapes was investigated; those authors proved that good audiological outcomes could be achieved with this approach . Unfortunately, information about the presence of the malleus handle was lacking in the majority of our cases, indicating the limitations of retrospective data reporting on one hand and the importance of detailed surgical description on the other …”

Section: Discussionsupporting

confidence: 90%

“…Our data are in agreement with another study in which TORP with an intact stapes was investigated; those authors proved that good audiological outcomes could be achieved with this approach. 23 Unfortunately, information about the presence of the malleus handle was lacking in the majority of our cases, indicating the limitations of retrospective data reporting on one hand and the importance of detailed surgical description on the other. 24 Interestingly, the creation or obliteration of an open mastoid cavity had no effect on audiological outcome in our cohort.…”

Section: Discussionmentioning

confidence: 85%

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Comparison of total and partial ossicular replacement prostheses in patients with an intact stapes suprastructure

Weiss

Großmann

et al. 2019

The Laryngoscope

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Objectives To compare the results of ossiculoplasty with two different partial ossicular replacement prostheses (PORP) to ossiculoplasty with a total ossicular replacement prosthesis (TORP) in patients with an intact stapes suprastructure. Methods All patients required primary or revision surgery for chronic middle ear disease and ossicular reconstruction with either a PORP or a TORP, as well as a with an intact stapes suprastructure. In total, 141 patients receiving classic tympanoplasty with PORP (N = 92), ossiculoplasty with PORP with ball joint (N = 22), or TORP (N = 27) between January 2011 and March 2017 were included in this study. The inclusion criterion was an intact stapes suprastructure. The underlying indication for surgery was either middle ear disease, such as cholesteatoma, or revision surgery for audiological improvement. The main outcome measures were four‐frequency pure tone average (0.5, 1, 2, 3 kHz) at early and late follow‐up after ossiculoplasty, the effects of clinical factors including the underlying middle ear disease, and primary or revision surgery. Results All patients showed a significantly reduced air‐bone gap (ABG 0.5, 1, 2, 3 kHz) at late follow‐up (mean: 18 dB) compared to preoperative measurements (mean: 25.5 dB). A significantly better outcome in ABG closure was shown among patients with a preoperatively intact tympanic membrane, with an intact stapes suprastructure or without preexisting cholesteatoma. Outcome was not significantly influenced by the prosthesis‐type, the creation of an open mastoid cavity, the status of the mucosa, or the indication for surgery. Conclusion TORP with an intact stapes suprastructure is a safe procedure and provides audiological outcomes similar to PORP. Level of Evidence 2C Laryngoscope, 130:768–775, 2020

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 85%

Comparison of total and partial ossicular replacement prostheses in patients with an intact stapes suprastructure

Weiss

Großmann

et al. 2019

The Laryngoscope

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“…Alternatively, a slight movement of a PORP can result in changes in the axis or fulcrum of the ossicular chain and affect the sound transfer process. 24 PORP results showed a better success and hearing outcome than TORP, which could be explained by poor stability and inadequate coupling at the TORP-footplate interface of the prosthesis, but it was statically insignificant, which is agreed with other studies. 16,25 In recent study done by Roux et al on 68 patients that compared the hearing outcome between two groups who underwent titanium ossiculoplasty in CWU cases due to cholesteatoma, the results showed that the control of ossicular prosthesis positioning via the posterior tympanotomy does not improve hearing results after ossicular chain reconstruction in cholesteatoma surgery.…”

Section: Discussionsupporting

confidence: 90%

“…The shaft of the TORP needs to be displaced by only a fraction of a millimeter for it to get disconnected from the footplate and fall down. Alternatively, a slight movement of a PORP can result in changes in the axis or fulcrum of the ossicular chain and affect the sound transfer process …”

Section: Discussionmentioning

confidence: 99%

The benefit of trans‐attic endoscopic control of ossicular prosthesis after cholesteatoma surgery

et al. 2019

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Objective To show the efficiency of using transmastoid atticotomy (TMA) endoscopy on the outcome of ossiculoplasty in patients with cholesteatoma. TMA is often performed as part of the surgical management of patients with middle ear cholesteatoma extending to the epitympanum. TMA can also be used as an access for endoscopic view to confirm the right alignment and stability of the ossicular prosthesis because the reconstruction of the tympanic membrane will obscure the visualization of the prosthesis. Methods A retrospective study was done at a tertiary referral institute, including 133 ears with cholesteatoma that underwent canal wall‐up tympanomastoidectomy (CWU) with ossicular reconstruction using titanium prosthesis between August 2013 and August 2015. Post packing of the ear canal and position, stability, and axis of the prosthesis were checked using endoscope positioned in the attic through TMA. A postoperative pure‐tone average air–bone gap (ABG) of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups. Results Of the 133 ears, 88 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), whereas the rest (45 patients) had total ossicular replacement prosthesis (TORP). A postoperative ABG ≤ 20 dB was obtained in 77.4% of all the patients (79.5% for PORP; 73.3% for TORP). Conclusion Endoscopic assessment of the ossicular prosthesis via the attic, after repositioning of the tympanomeatal flap and packing the ear canal, decreases the risk of immediate ossiculoplasty failure and improves the functional outcome after ossicular chain reconstruction in cholesteatoma surgery. Level of Evidence 4 Laryngoscope, 129:2754–2759, 2019

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“…While some literature sees TORP reconstruction in cholesteatoma ears less favorable compared with PORPs or the intact ossicular chain (2,7) other studies have shown different results (8). Furthermore, the analyzed cohort consists of patients with mostly longstanding middle ear ventilation problems, with 75% of them already having had previous ear surgeries for cholesteatoma.…”

Section: Discussionmentioning

confidence: 98%

Long-term Follow-up Study of the Sandwich Cartilage Shoe Technique in Cases of Insecure Stapes Footplate

Lüers

Schwarz

Anagiotos

et al. 2016

Otology &Amp; Neurotology

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The sandwich cartilage shoe technique offers a safe and effective option as a two-stage procedure in treating patients with fractures of the stapes footplate in case of chronic otitis media. In view of the possible risk of deafness going along with a destruction of an inner ear window, our results can be considered substantial as all our patients will at least be able to regain "social hearing" as they all either achieved a hearing threshold is less than 30 dB or can be sufficiently supplied with a conventional hearing aid.

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Ossiculoplasty With Titanium Prostheses in Patients With Intact Stapes

Cited by 31 publications

References 16 publications

Comparison of total and partial ossicular replacement prostheses in patients with an intact stapes suprastructure

Comparison of total and partial ossicular replacement prostheses in patients with an intact stapes suprastructure

The benefit of trans‐attic endoscopic control of ossicular prosthesis after cholesteatoma surgery

Long-term Follow-up Study of the Sandwich Cartilage Shoe Technique in Cases of Insecure Stapes Footplate

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