title: Prosthetic reconstruction from the tympanic membrane to the stapes head or to the stapes footplate? A laser Doppler study.
abstract: BACKGROUND
  In the absence of the incus, many surgeons believe that reconstruction from the tympanic membrane to the stapes head is more effective than reconstruction to the stapes footplate. This has rarely been tested empirically. Published better clinical results with reconstruction to the stapes head might simply reflect less underlying disease in ears with an intact stapes superstructure.
  
  
  OBJECTIVE
  To compare vibration transmission of these two forms of prosthetic reconstruction.
  
  
  METHODS
  A fresh human cadaveric temporal bone model was used. Round window vibrations in response to sound in the ear canal were measured with a laser Doppler vibrometer. After incus removal, the discontinuity was repaired using a titanium prosthesis. Reconstruction from the tympanic membrane to the stapes head was compared to reconstruction to the stapes footplate.
  
  
  RESULTS
  Reconstruction of both types decreased round window vibrations by 10 to 15 dB between 500 and 3000 Hz compared to the intact middle ear. Reconstruction to the stapes head performed 5 to 10 dB better at lower frequencies (500-2000 Hz), but this was only statistically significant at 1 and 2 kHz.
  
  
  CONCLUSIONS
  There is only a 5 to 10 dB mechanical advantage gained by reconstruction from the tympanic membrane to the stapes head compared to reconstruction to the footplate for frequencies between 1 and 2 kHz.
authors.affiliation: Department of Anatomy and Neurobiology, Dalhousie University, Halifax, NS.
authors.forename: Wael A
authors.initials: WA
authors.lastname: Alian
authors.forename: Osama F
authors.initials: OF
authors.lastname: Majdalawieh
authors.forename: Rene G
authors.initials: RG
authors.lastname: Van Wijhe
authors.forename: Hasse
authors.initials: H
authors.lastname: Ejnell
authors.forename: Manohar
authors.initials: M
authors.lastname: Bance
mesh_terms: D000161:Acoustic Stimulation; D001844:Bone Conduction; D002102:Cadaver; D034381:Hearing Loss / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007188:Incus / Q000503:physiopathology* / Q000601:surgery; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D009998:Ossicular Prosthesis; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D012405:Round Window, Ear / Q000503:physiopathology / Q000601:surgery; D013199:Stapes / Q000503:physiopathology*; D013701:Temporal Bone / Q000503:physiopathology / Q000601:surgery; D014025:Titanium; D014432:Tympanic Membrane / Q000503:physiopathology* / Q000601:surgery; D014732:Vibration
chemical_list: D014025:Titanium