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Cartilage ‘shoe’: a new technique for stabilisation of titanium total ossicular replacement prosthesis at centre of stapes footplate

Published online by Cambridge University Press:  08 March 2017

D Beutner
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Germany
J C Luers
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Germany
K B Huttenbrink*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Germany
*
Address for correspondence: Prof Karl-Bernd Huttenbrink, Professor and Chairman, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany. Fax: +49 221 478 4793 E-mail: huttenbrink.k-b@uni-koeln.de

Abstract

Objectives:

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.

Type
Main Article
Copyright
Copyright © JLO (1984) Limited 2008

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References

1 Huttenbrink, KB. Biomechanical aspects of middle ear reconstruction. In: Jahnke, K, ed. Current Topics in Otolaryngology - Head and Neck Surgery. Middle Ear Surgery: Recent Advances and Future Directions. Stuttgart: Thieme, 2004;2351Google Scholar
2 Huttenbrink, KB. Surgical treatment of chronic otitis media. III: Middle ear reconstruction [in German]. HNO 1994;42:701–18Google Scholar
3 Katzke, D, Steinbach, E, Schodermaier, C. The evaluation of allogenous incus transplants removed during revision tympanoplasty [in German]. Arch Otorhinolaryngol 1982;235:525–8CrossRefGoogle Scholar
4 Smyth, GDL. TORPS: how have they fared after five years? J Laryngol Otol 1983;97:991–3CrossRefGoogle Scholar
5 Huttenbrink, KB, Zahnert, T, Wustenberg, EG, Hofmann, G. Titanium clip prosthesis. Otol Neurotol 2004;25:436–42CrossRefGoogle ScholarPubMed
6 Fisch, U, May, J. Tympanoplasty, Mastoidectomy and Stapes Surgery. Stuttgart, New York: Thieme, 1994Google Scholar
7 Murbe, D, Zahnert, T, Bornitz, M, Huttenbrink, KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope 2002;112:1769–76CrossRefGoogle ScholarPubMed
8 Zahnert, T, Huttenbrink, KB, Murbe, D, Bornitz, M. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol 2000;21:322–8CrossRefGoogle ScholarPubMed
9 Huttenbrink, KB, Zahnert, T, Beutner, D, Hofmann, G. The cartilage guide: a solution for anchoring a columella-prosthesis on footplate [in German]. Laryngorhinootologie 2004;83:450–6Google Scholar
10 Dalchow, CV, Grun, D, Stupp, HF. Reconstruction of the ossicular chain with titanium implants. Otolaryngol Head Neck Surg 2001;125:628–30CrossRefGoogle ScholarPubMed
11 Ho, SY, Battista, RA, Wiet, RJ. Early results with titanium ossicular implants. Otol Neurotol 2003;24:149–52CrossRefGoogle ScholarPubMed
12 Krueger, 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
13 McComb, H. Osseointegrated titanium implants for the attachment of facial prostheses. Ann Plast Surg 1993;31:225–32CrossRefGoogle ScholarPubMed
14 Schwager, K. Titanium as an ossicular replacement material: results after 336 days of implantation in the rabbit. Am J Otol 1998;19:569–73Google ScholarPubMed
15 Schwager, K. Titanium as a biomaterial for ossicular replacement: results after implantation in the middle ear of the rabbit. Eur Arch Otorhinolaryngol 1998;255:396401CrossRefGoogle ScholarPubMed
16 Eiber, A, Freitag, HG, Schimanski, G, Zenner, HP. On the coupling of prostheses to the middle ear structure and its influence on sound transfer. In: Rosowski, JJ, Merchant, SN, eds. Second International Symposium on Middle-Ear Mechanics in Research and Otosurgery, Kugler Publications: The Hague, The Netherlands, 2000;297308Google Scholar
17 Jahnke, K. Progress in microsurgery of the middle ear [in German]. HNO 1987;35:113Google Scholar
18 Plester, D, Hildmann, H, Seinbach, E. Atlas of Ear Surgery [in German]. The Netherlands: Kohlhammer Verlag, 1989Google Scholar
19 Berenholz, LP, Rizer, FM, Burkey, JM, Schuring, AG, Lippy, WH. Ossiculoplasty in canal wall down mastoidectomy. Otolaryngol Head Neck Surg 2000;123:30–3CrossRefGoogle ScholarPubMed
20 Brackmann, DE, Sheehy, JL, Luxford, WM. TORPs and PORPs in tympanoplasty: a review of 1042 operations. Otolaryngol Head Neck Surg 1984;92:32–7CrossRefGoogle ScholarPubMed
21 Farrior, JB, Nichols, SW. Long-term results using ossicular grafts. Am J Otol 1996;17:386–92Google ScholarPubMed
22 Goldenberg, RA, Driver, M. Long-term results with hydroxylapatite middle ear implants. Otolaryngol Head Neck Surg 2000;122:635–42CrossRefGoogle ScholarPubMed
23 House, JW, Teufert, KB. Extrusion rates and hearing results in ossicular reconstruction. Otolaryngol Head Neck Surg 2001;125:135–41CrossRefGoogle ScholarPubMed
24 Quaranta, N, Fernandez-Vega, FS, Piazza, F, Zini, C. Closed tympanoplasty in cholesteatoma surgery: long-term (10 years) hearing results using cartilage ossiculoplasty. Eur Arch Otorhinolaryngol 2001;258:20–4CrossRefGoogle ScholarPubMed
25 Zenner, HP, Stegmaier, A, Lehner, R, Baumann, I, Zimmermann, R. Open Tubingen titanium prostheses for ossiculoplasty: a prospective clinical trial. Otol Neurotol 2001;22:582–9CrossRefGoogle ScholarPubMed
26 Anson, JB, Donaldson, JA. Surgical Anatomy of the Temporal Bone and Ear, 2nd edn. Philadelphia, USA: WB Saunders, 1973Google Scholar
27 Asai, M, Huber, AM, Goode, RL. Analysis of the best site on the stapes footplate for ossicular chain reconstruction. Acta Otolaryngol 1999;119:356–61Google ScholarPubMed
28 Neudert, M, Berner, M, Bornitz, M, Beleites, T, Ney, M, Zahnert, T. Osseointegration of prostheses on the stapes footplate: evaluation of the biomechanical feasibility by using a finite element model. J Assoc Res Otolaryngol 2007;8:411–21CrossRefGoogle ScholarPubMed
29 Sudhoff, H, Lindner, N, Gronemeyer, J, Dazert, S, Hildmann, H. Study of osteointegration of a titanium prosthesis to the stapes: observations on an accidentally extracted stapes. Otol Neurotol 2005;26:583–6CrossRefGoogle Scholar