To compare the efficacy of Titanium versus Teflon piston on hearing outcome in terms of Air conduction gain and Air Bone Gap closure in LASER Stapedotomy – A retrospective study

Abstract

Aim: To determine the efficacy of Titanium versus Teflon piston on hearing outcome in terms of Air Conduction Threshold (ACT) gain and Air Bone Gap (ABG) closure in patients undergoing LASER Stapedotomy. Methods: This retrospective study was conducted at the department of ENT and Head and Neck Surgery, AIIMS Patna. 40 patients underwent LASER stapedotomy. Both Teflon (0.4mm and 0.6mm D, Grace Medical Devices) and Titanium (0.4mm D, Kurz Medical Devices) pistons were inserted randomly. Crimping of titanium Kurz piston was not required due to its unique design which fits on to the incus long process like a clip whereas all the Teflon pistons required crimping.Titanium (Kurz Medical Devices) pistons are costlier in comparison to Teflon (Grace Medical Devices) pistons. Preoperative and 3 monthly postoperative Pure Tone Audiograms (PTA) wereobtained. ACT (Air conduction threshold) gain and ABG (Air Bone Gap) closure were measured.Data was analyzed with IBM SPSS Statistics software Version 20. Descriptive analysis,paired and unpaired t-tests were applied. P-value of <0.05 at 95% confidence levels was considered statistically significant. Results: 40 patients (M: F: 3:7) underwent LASER stapedotomy.Titanium piston was utilized in 11and Teflon in 29 patients. Patients with titanium piston experienced a mean ACT gain of 21.51±05.42dBand mean ABG closure of 12.27±05.18 dB. Those with Teflon piston gained a meanACT gain of 18.54±04.43 dB and mean ABG closure of11.96±06.12 dB.Both groups experienced statistically significant hearing gain (p <0.05).Both groups were however comparable and the difference between these parameters was statistically insignificant (p>0.05).Conclusion: Both titanium and Teflon pistons are equally efficacious in improving postoperative hearing gain in LASER stapedotomy patients in terms of ACT gain and ABG closure. Titanium Kurz pistons do not require crimping making it easier to use in comparison to the Teflon pistons which needs to be crimped every time though cost may be a limiting factor in the usage of Titanium pistons.Both types of pistons can be satisfactorily employed in this surgical procedure if we consider the hearing gain post operatively. Study design: A retrospective observational study Keywords: Otosclerosis, Teflon, Titanium, Air Conduction Threshold (ACT), Air Bone Gap (ABG) closure