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Autologous total ossicular replacement prosthesis

Published online by Cambridge University Press:  11 November 2014

M Malhotra ,
S Varshney  and
R Malhotra
M Malhotra*
Affiliation:
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
S Varshney
Affiliation:
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
R Malhotra
Affiliation:
Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
*
Address for correspondence: Dr Manu Malhotra, 3/4, Type IV, AIIMS, Rishikesh 249201, Uttarakhand, India E-mail: manumalhotrallrm@gmail.com
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Abstract

Objective:

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.

Keywords

Ear, MiddleAutograftsCartilageTympanoplastyOssicular Replacement ProsthesesOtologic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 12 , December 2014 , pp. 1050 - 1055
Copyright
Copyright © JLO (1984) Limited 2014 

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References

1Yung, M. Cartilage tympanoplasty: literature review. J Laryngol Otol 2008;122:663–72CrossRefGoogle ScholarPubMed
2Merchant, SN, McKenna, MJ, Rosowski, JJ. Current status and future challenges of tympanoplasty. Eur Arch Otorhinolaryngol 1998;255:221–8CrossRefGoogle ScholarPubMed
3Salen, B. Myringoplasty using septum cartilage. Acta Otolaryngol Suppl 1963;(suppl 188):82–91Google Scholar
4Jansen, C. Cartilage tympanoplasty. Laryngoscope 1963;13:1288–302CrossRefGoogle Scholar
5Sheehy, JL. Otologic homografts. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol 1975;80:37–40Google Scholar
6Tjellstrom, A, Lindström, J, Albrektsson, T, Brånemark, PI, Hallén, O. A clinical pilot study on preformed, autologous ossicles. I. Acta Otolaryngol 1978;85:33–9CrossRefGoogle ScholarPubMed
7Tjellstrom, A, Lindström, J, Albrektsson, T, Brånemark, PI, Hallén, O. A clinical pilot study on preformed, autologous ossicles. II. Acta Otolaryngol 1978;85:232–42Google Scholar
8Tjellstrom, A, Albrektsson, T. A five-year follow-up of preformed, autologous ossicles in tympanoplasty. J Laryngol Otol 1985;99:729–33CrossRefGoogle ScholarPubMed
9Kapur, TR, Jayaramachandran, S. Long-term results of total ossicular chain reconstruction using autografts. J Laryngol Otol 1992;106:688–91Google Scholar
10Lacosta, JL, Infante, JC, Pisón, F. Functional surgery of cholesteatoma. I. Closed techniques [in Spanish]. Acta Otorrinolaringol Esp 1997;48:115–20Google ScholarPubMed
11Malard, O, Daculsi, G, Toquet, J, Beauvillain De Montreuil, C, Legent, F, Bordure, P. Autografts versus biomaterials for ossiculoplasty with normal stapes; a comparative analysis of functional outcome in 100 cases [in French]. Ann Otolaryngol Chir Cervicofac 2001;118:225–31Google Scholar
12Zenner, HP, Stegmaier, A, Lehner, R, Baumann, I, Zimmermann, R. Open Tubingen titanium prostheses for ossiculoplasty: a prospective clinical trial. Otol Neurotol 2001;22:582–9Google Scholar
13Krueger, WW, Feghali, JG, Shelton, C, Green, JD, Beatty, CW, Wilson, DF et al. Preliminary ossiculoplasty results using the Kurz titanium prostheses. Otol Neurotol 2002;23:836–9CrossRefGoogle ScholarPubMed
14Martin, AD, Harner, SG. Ossicular reconstruction with titanium prosthesis. Laryngoscope 2004;114:61–4CrossRefGoogle ScholarPubMed
15Monsell, M, Balkany, TA, Gates, GA, Goldenberg, RA, Meyerhoff, WL, House, JW. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 1995;113:186–7Google Scholar
16Roth, JA, Pandit, SR, Soma, M, Kertesz, TR. Ossicular chain reconstruction with a titanium prosthesis. J Laryngol Otol 2009;123:1082–6Google Scholar
17Merchant, SN, McKenna, MJ, Rosowski, JJ. Current status and future challenges of tympanoplasty. Eur Arch Otorhinolaryngol 1988;255:221–8CrossRefGoogle Scholar
18Kerr, AG, Smyth, GDL. The fate of transplanted ossicles. J Laryngol Otol 1971;85:337–47Google Scholar
19Merchant, SN, Nadol, JB Jr.Histopathology of ossicular implants. Otolaryngol Clin North Am 1994;27:813–33CrossRefGoogle ScholarPubMed
20Schuknecht, HF, Shi, SR. Surgical pathology of middle ear implants. Laryngoscope 1985;95:249–58CrossRefGoogle ScholarPubMed
21Mills, RP, Cree, IA. Histological fate of cortical bone autografts in the middle ear. Clin Otolaryngol Allied Sci 1995;20:365–7CrossRefGoogle ScholarPubMed
22Ojala, K, Sorri, M, Vainio-Mattila, J, Sipilä, P. Late results of tympanoplasty using ossicle or cortical bone. J Laryngol Otol 1983;97:19–25Google Scholar
23Mills, RP. The use of cortical bone grafts in ossiculoplasty. I: Surgical techniques and hearing results. J Laryngol Otol 1993;107:686–9CrossRefGoogle ScholarPubMed
24Ceccato, S, Portmann, D, Davis, RW. Type III ossiculoplasty with mastoid cortical bone – ‘in situ’ shaping of the ossicle. Rev Laryngol Otol Rhinol (Bord) 2009;130:203–4Google ScholarPubMed
25Gardner, EK, Jackson, CG, Kaylie, DM. Results with titanium ossicular reconstruction prostheses. Laryngoscope 2004;114:65–70Google Scholar
26Fisch, U, May, J, Linder, T, Naumann, IC. A new L-shaped titanium prosthesis for total reconstruction of the ossicular chain. Otol Neurotol 2004;25:891–902Google Scholar
27Elwany, S. Histochemical study of cartilage autografts in tympanoplasty. J Laryngol Otol 1985;99:637–42CrossRefGoogle ScholarPubMed
28Malhotra, M. ‘Umbrella’ graft tympanoplasty. J Laryngol Otol 2010;124:377–81CrossRefGoogle ScholarPubMed
29Dornhoffer, JL, Gardner, E. Prognostic factors in ossiculoplasty: a statistical staging system. Otol Neurotol 2001;22:299–304CrossRefGoogle ScholarPubMed
30Austin, DF. Ossicular reconstruction. Arch Otolaryngol 1971;94:525–35Google Scholar
31Black, B. Ossiculoplasty prognosis: the SPITE method of assessment. Am J Otol 1992;13:544–51Google ScholarPubMed
32Albu, S, Babighian, G, Trabalzini, F. Prognostic factors in tympanoplasty. Am J Otol 1998;19:136–40Google ScholarPubMed
33Fisch, U. Tympanoplasty, Mastoidectomy, and Stapes Surgery. Stuttgart: Thieme, 1994;108–15Google Scholar
34Martin, J, Silva, H, Certal, V, Amorim, H, Carvalho, C. Ossiculoplasty with titanium prosthesis [in Spanish]. Acta Otorrinolaringol Esp 2011;62:295–9Google Scholar
35Mardassi, A, Deveze, A, Sanjuan, M, Mancini, J, Parikh, B, Elbedeiwy, A et al. Titanium ossicular chain replacement prosthesis: prognostic factors and preliminary functional results. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:53–8CrossRefGoogle ScholarPubMed
36Berenholz, L, Burkey, J, Lippy, W. Total ossiculoplasty: advantages of two-point stabilization technique. Int J Otolaryngol 2012;2012:346260CrossRefGoogle ScholarPubMed