Ossicular reconstruction with titanium prosthesis.

Abstract

To evaluate the results when using titanium total ossicular replacement prosthesis (TORP) or partial ossicular replacement prosthesis (PORP) in chronic ear disease. Retrospective chart review was performed. Sixty-eight ossicular procedures using a titanium TORP (n = 30) or PORP (n = 38) were performed at a tertiary referral center between December 1999 and June 2002. The ossiculoplasty was performed either alone or in combination with other chronic ear surgery. Cartilage grafts were used universally. Nineteen percent were primary operations, and 6% were planned second stages. The majority were revision procedures. Follow-up ranged from 3 months to 2.5 years. The prosthesis is easy to insert, well tolerated, and has a low extrusion rate. Average air-bone gap (ABG) improvement was 13 dB with closure of the ABG to within 20 dB in 57% of cases. Hearing results were better for primary versus revision cases for PORPs versus TORPs and for intact canal wall (ICW) procedures versus canal wall-down (CWD) procedures. Titanium is a satisfactory material for use in ossicular reconstruction because of its ease of insertion, tissue tolerance, and low rate of extrusion. Caution is advised when selecting candidates for this procedure during revision surgery, especially if the canal wall and stapes superstructure are absent.