Partial ossicular reconstruction: comparison of three different prostheses in clinical and experimental studies.
OBJECTIVE
To compare the reconstruction results of a long incus process defect using 3 different partial ossicular replacement prostheses (PORP).


METHODS
Temporal bone experiments and retrospective case review.


METHODS
Tertiary referral center. EXPERIMENTAL MATERIAL AND PATIENTS: The experimental study was performed on 18 temporal bones; 66 patients with retraction pockets, chronic otitis media with or without cholesteatoma.


METHODS
Ossiculoplasty using 3 different PORP: titanium angle prosthesis, autologous incus interposition, and titanium clip prosthesis.


METHODS
Laser Doppler vibrometry in temporal bones measured transmission properties of the PORP. Patients were retrospectively assessed up to 5 years after surgery. Audiologic data were analyzed for preoperative and postoperative air conduction and air-bone gap at 0.5, 1, 2, 3, and 4 kHz. Statistical analyses compared the outcome in the experimental and clinical setting.


RESULTS
Experimentally, the titanium PORP showed similar transmission properties because the overall difference to the intact specimen was -4.14 +/- 0.59 dB for the titanium angle prosthesis and -4.61 +/- 0.57 dB for the titanium clip prosthesis. The transmission after an autologous incus interposition was significantly worse (-9.32 +/- 0.39 dB, p < or = 0.001) compared with the other prostheses. Patients' mean postoperative air-bone gap was 25.5 +/- 1.2 dB and less than 20 dB in at least 66% of cases without any significant differences between the groups.


CONCLUSIONS
In the clinical setting, the confounding factors that influence the acoustic outcome after partial ossiculoplasty obscure the prosthesis-related transmission factors that can otherwise be derived in the experimental setting. The results do not generally favor the use of 1 specific prosthesis, rather they suggest that the correct choice of a prosthesis be based on the anatomic and pathophysiologic conditions found in the individual patient.
Neudert
Marcus
M
Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Germany. marcus.neudert@uniklinikum-dresden.de
Zahnert
Thomas
T
Lasurashvili
Nikoloz
N
Bornitz
Matthias
M
Lavcheva
Zlatina
Z
Offergeld
Christian
C
D000161:Acoustic Stimulation; D000328:Adult; D001299:Audiometry; D001301:Audiometry, Pure-Tone; D001844:Bone Conduction / Q000502:physiology; D002781:Cholesteatoma / Q000150:complications / Q000601:surgery; D003627:Data Interpretation, Statistical; D004429:Ear Ossicles / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement / Q000379:methods*; D010033:Otitis Media / Q000150:complications / Q000601:surgery; D013506:Otologic Surgical Procedures; D013199:Stapes / Q000473:pathology; D013701:Temporal Bone / Q000473:pathology; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000150:complications / Q000601:surgery; D014433:Tympanoplasty