title: A new prosthesis for reconstructing the incudostapedial joint.
abstract: OBJECTIVE
  This study aimed to evaluate the hearing results obtained using the Silverstein Incus-Stapes Connection in ossicular reconstruction among patients with chronic ear disease.
  
  
  METHODS
  The study was performed as a retrospective review. A control group consisted of patients undergoing similar surgery but in which no prosthesis was used.
  
  
  METHODS
  The Florida Ear and Sinus Center outpatient offices of the senior author.
  
  
  METHODS
  Forty-seven patients with a mean age of 48 years comprised the treatment group. Thirty-eight patients (mean age, 49.4 years) acted as control subjects.
  
  
  METHODS
  All patients underwent surgery for chronic ear disease. Reconstruction surgery for patients requiring separation of the incudostapedial was performed with a Silverstein Incus-Stapes Connection or by reapproximating the joint capsule to allow primary healing.
  
  
  METHODS
  The patients were categorized according to how the prosthesis was used. Results comparing the preoperative air-bone gap and postoperative air-bone gap were evaluated. The change in air-bone gap was reported according to the guidelines set forth by the Committee on Hearing and Equilibrium.
  
  
  RESULTS
  The mean postoperative air-bone gap for reconstruction with the prosthesis was 17.6 dB compared to a mean of 11.8 dB among control subjects. An air-bone gap of 16.5 dB was achieved when the prosthesis was used to bridge an area of lenticular resorption. When a composite prosthesis, made by adding cartilage to the disk, was used to bridge larger defects, an air-bone gap of 14.3 dB was seen. Finally, when the prosthesis was used as a partial ossicular replacement prosthesis and directly contacted the tympanic membrane, the air-bone gap was 9 dB. The prosthesis was found to be stable when re-exploration was required and modification of the prosthesis with cartilage was accomplished easily intraoperatively.
  
  
  CONCLUSIONS
  The Silverstein Incus-Stapes Connection is a middle ear prosthesis that can provide a mechanism for overcoming incus resorption in selected cases. In addition, the prosthesis can be modified easily with the addition of cartilage when needed.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Nadel
authors.forename: H
authors.initials: H
authors.lastname: Silverstein
authors.forename: M J
authors.initials: MJ
authors.lastname: Olds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005500:Follow-Up Studies; D006311:Hearing Disorders / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007188:Incus / Q000601:surgery*; D008875:Middle Aged; D009998:Ossicular Prosthesis; D010033:Otitis Media / Q000150:complications; D012189:Retrospective Studies; D013201:Stapes Surgery