title: Hearing results using the SMart piston prosthesis.
abstract: OBJECTIVE
  SMart, a newly introduced piston prosthesis for stapedotomy, is a nitinol-based, heat-activated, self-crimping prosthesis. We review our hearing results and postoperative complications using this self-crimped piston prosthesis and compare them with those obtained using stainless steel or platinum piston prostheses.
  
  
  OBJECTIVE
  Audiometric results using the SMart piston are identical to those obtained using a conventional piston prosthesis.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Private neurotologic tertiary referral center.
  
  
  METHODS
  The 416 ears reviewed included 306 with a SMart prosthesis and 110 conventional prostheses. 61% were women. Mean follow-up time was 5.6 (standard deviation [SD], 6.3 mo) and 6.9 months (SD, 7.0 mo) for the 2 groups, respectively.
  
  
  METHODS
  Stapedotomy using the SMart or a conventional (non-SMart) prosthesis.
  
  
  METHODS
  Audiometric hearing results, including pure-tone average (PTA) and air-bone gap (ABG), and prevalence of postoperative complications.
  
  
  RESULTS
  Mean postoperative PTA was 32.6 (SD, 16.8) dB for the SMart group and 29.4 (SD, 13.5) dB for the non-SMart group, with ABGs of 7.6 (SD, 8.9) and 6.0 (SD, 5.2) dB, respectively. Mean change (decrease) in ABG was 18.7 (SD, 13.1) dB for the SMart group and 19.9 (SD, 10.3) dB for the non-SMart group. High-frequency bone PTAs showed overclosure of 2.0 (SD, 7.9) dB for the SMart group and 3.6 (SD, 8.6) dB for the non-SMart group. Postoperative vertigo and tinnitus were infrequent. No significant differences in these audiometric outcomes or complication rates were noted between groups. There was no significant difference in rate of gap closure to within 10 dB (78.3 versus 84.2%, SMart and non-SMart, respectively) or 20 dB (94.2 and 98.0%).
  
  
  CONCLUSIONS
  Compared with conventional stapes prostheses, the nitinol-based SMart is a safe and reliable stapes prosthesis that eliminates manual crimping without significantly altering the audiometric outcome. Complications are rare, but longer follow-up is needed before establishing long-term stability.
authors.affiliation: House Ear Institute and House Ear Clinic, Los Angeles, California 90057, USA. jfayad@hei.org
authors.forename: Jose N
authors.initials: JN
authors.lastname: Fayad
authors.forename: Maroun T
authors.initials: MT
authors.lastname: Semaan
authors.forename: Josh C
authors.initials: JC
authors.lastname: Meier
authors.forename: John W
authors.initials: JW
authors.lastname: House
mesh_terms: D000328:Adult; D001301:Audiometry, Pure-Tone; D019929:Cochlear Implantation / Q000009:adverse effects; D003054:Cochlear Implants / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006309:Hearing / Q000502:physiology*; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013199:Stapes / Q000033:anatomy & histology; D013201:Stapes Surgery; D013651:Taste Disorders / Q000453:epidemiology / Q000209:etiology; D014012:Tinnitus / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014717:Vertigo / Q000453:epidemiology