Which is Better for Ossiculoplasty Following Tympanomastoidectomy: Polycel® or Titanium?

Abstract

Objectives: The purpose of this study was to compare the surgical outcomes of Polycel® and titanium in ossiculoplasty following tympanomastoidectomy (TM). Methods: A total of 221 patients underwent ossiculoplasty following TM by a single surgeon using either Polycel® or titanium as prosthesis. Hearing was tested preoperatively and postoperatively at 6 months by pure-tone audiometry. Successful surgery was defined if postoperative air-bone gap (ABG) was <20 dB, the gain in air conduction (AC) hearing was >15 dB HL, or postoperative AC was <30 dB HL. Multiple linear regression was conducted to identify the factors associated with the surgical outcomes. Results: In canal wall up mastoidectomy (CWUM), both Polycel® and titanium showed favorable successful rates if partial ossicular replacement prosthesis (PORP) was used (64.3% of Polycel® and 67.6% in titanium). If total ossicular replacement prosthesis (TORP) was used, both represented similar outcomes (54.5% of Polycel® and 75.0% in titanium). In canal wall down mastoidectomy (CWDM), significant ABG reductions were observed only in the titanium group (5.2 ± 14.7 dB of Polycel® [ P = .083] and 7.0 ± 14.2 dB of titanium [ P = .002] in PORP; 4.6 ± 13.5 dB of Polycel® [ P = .097] and 9.5 ± 11.2 dB of titanium [ P < .001] in TORP). In multivariate analysis, titanium had a positive effect on the reduction of postoperative AC thresholds (B: −4.772; 95% CI: −8.706-−0.838). Conclusions: Both Polycel® and titanium showed favorable surgical outcomes for ossiculoplasty following CWUM. Titanium prosthesis is recommended for surgery after CWDM.

Titanium Biohybrid Middle Ear Prostheses: A Preliminary In Vitro Study

“…The modern approach to middle ear (ME) surgery, which combines both disease removal and functional reconstruction, dates back to the 1950s [1]. Ossiculoplasty (OPL) is an established surgical procedure intended to restore appropriate sound-wave transmission from the tympanic membrane to the oval window via a reconstructed ossicular chain [2]. It often represents the rehabilitative stage after eradication of various ME pathologies, including chronic otitis media, adhesive otitis media, atelectasis, tympanosclerosis, tumors, traumatic injuries, and congenital diseases, which may damage the chain and lead to conductive hearing loss [3].…”

“…Still today, autologous incus refashioned to provide customized interposition remains one of the reconstruction techniques of choice due to its rare extrusion and low cost. Unfortunately, the availability and quality of patients' incus are often limited in diseased ears [2]. The autogenous mastoid cortical bone has been described as a satisfying and low-cost graft for minor ossicular defects [6,7].…”