title: Type III tympanoplasty with titanium total ossicular replacement prosthesis: anatomic and functional results.
abstract: OBJECTIVE
  To evaluate anatomical and functional results using titanium prostheses in cartilage palisade tympanoplasties.
  
  
  METHODS
  Retrospective clinical study. Data were collected from patients' charts and clinical review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Cartilage tympanoplasty with titanium total ossicular replacement prosthesis after tympanoplasty or tympanomastoidectomy in patients operated on between July 1998 and February 2006.
  
  
  METHODS
  Anatomical results (closure of the perforation, rate of retraction pockets, recurrent cholesteatoma, and extrusion and re-perforation rates) were clinically evaluated. Pure-tone averages of air and bone conduction were analyzed. A postoperative air-bone gap (ABG) of 20 dB or less was taken to represent successful hearing.The hearing outcomes of canal wall up (CWU), canal wall down (CWD), primary and revision surgeries, and 2 groups of a short-term (<12 mo) or long-term (>24 mo) follow-up (f-u) were assessed and compared.
  
  
  RESULTS
  Ninety-four cases were observed during the visiting period: 43 (45.7%) underwent primary procedures and 51 (54.3%) underwent revision surgeries. Closure of the tympanic membrane was achieved in 98.9%.Postoperative ABG was 20 dB or lower in 62 (66%) of 93 cases, between 11 and 20 dB in 33 cases (35%), and 10 dB or lower in 29 cases (31%).All cases undergoing CWU had a mean +/- SD postoperative ABG of 14.59 +/- 11.28 dB. There were no statistically significant differences (independent-samples t test, p = 0.5) between these patients and those receiving CWD surgery (15.95 +/- 10 dB).Thirty-eight (68%) of 56 CWD and 24 (64%) of 37 CWU cases achieved a postoperative ABG between 0 and 20 dB (chi = 0.08, p = 0.7, correlation = 0.031).Thirty-three (64.7%) of 51 who underwent revision surgeries and 29 (69%) of 42 who underwent primary procedures had a postoperative ABG between 0 and 20 dB. The difference between the groups was not significant (chi = 0.3, correlation = 0.058, p = 0.5).The mean ABG in the short f-u group was 12.38 +/- 7.34. There was no significant difference regarding long-term f-u after 24 months (11.76 +/- 8.9; Wilcoxon signed-rank test, p = 0.7).We compared the mean postoperative ABG in low hearing frequencies (500 and 1,000 Hz) and high hearing frequencies (2,000 and 4,000 Hz). A better sound transmission was achieved in high frequencies (10.32 +/- 10.6 versus 20.61 +/- 13.73 dB, respectively); the difference was statistically significant (p < 0.001, paired-samples t test).
  
  
  CONCLUSIONS
  Our results suggest that tympanoplasty with titanium total ossicular replacement prosthesis reconstruction offers a stable improvement of the ABG less than 20 dB in 66% of cases, in both short-term and long-term f-u. There were no differences in the results between CWU and CWD or between primary and revision surgery. The titanium prosthesis achieves the best acoustical results for sound transmission at high frequencies (2,000 and 4,000 Hz).
authors.affiliation: Servicio de ORL, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Iñiguez-Cuadra
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.forename: Antonio
authors.initials: A
authors.lastname: Borés-Domenech
authors.forename: Luis-Miguel
authors.initials: LM
authors.lastname: Menéndez-Colino
authors.forename: Miguel
authors.initials: M
authors.lastname: Caballero-Borrego
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
mesh_terms: D001301:Audiometry, Pure-Tone; D001844:Bone Conduction; D018424:Cholesteatoma, Middle Ear / Q000601:surgery; D034381:Hearing Loss / Q000601:surgery; D006801:Humans; D008416:Mastoid / Q000601:surgery*; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement / Q000295:instrumentation* / Q000379:methods*; D010033:Otitis Media / Q000601:surgery; D018579:Patient Selection; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*; D014433:Tympanoplasty / Q000295:instrumentation* / Q000379:methods*