Ossicular Reconstruction Prosthesis Research Articles

Long-term outcomes following pediatric endoscopic titanium ossiculoplasty: A single-institution experience

IntroductionEndoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR outcomes in children, who have unique considerations including a smaller transcanal corridor and variable pathology. The purpose of this study was to investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted OCR in both the short and long-term. MethodsRetrospective review of all children (<17 years) who underwent endoscopic OCR at one tertiary care center between 2017 and 2021. Children undergoing primary and revision endoscopic OCR with either partial (PORP) and total ossicular reconstruction prostheses (TORP) were included. Children undergoing surgery for juvenile otosclerosis or congenital stapes fixation, or any child receiving a stapes prosthesis were excluded. Primary outcome measures were post-operative change in 4 frequency (500 Hz, 1, 2, 4 KHz) air conduction pure tone average (AC PTA) and change in air-bone gap (ABG). Secondary measures included need for readmission and/or revision surgery, complication rate, and surgery duration. ResultsSeventeen patients met inclusion criteria. Average age was 11.3 years (range, 5–17 years); 14 were male. A variety of fixed length, titanium total and partial prostheses were used. The most common prosthesis length was 2 mm (range 2–5 mm), and there were no intra- or perioperative complications. Mean long-term follow-up was 2.6 years. Most common pathology was congenital cholesteatoma (11/17, 64%), followed by chronic otitis media with tympanic membrane perforation (5/17, 29.4%), and extruded prosthesis (1/17, 5.9%). Intraoperatively, the most common finding was incus erosion (10/17, 58.8%), followed by malleus erosion (6/17, 35.3%), stapes erosion (4/17, 23.5%), and stapes absence (4/17, 23.5%). Eight children (47%) were reconstructed with PORPs, and 9 children (52.9%) were reconstructed with TORPs. Average ABG improved from 36.8 dB preoperatively to 19.9 dB postoperatively in the short-term and remained stable at 19.5 dB in the long-term. Average short-term ABG improvement was 4.2 dB for PORPs and 18 dB for TORPs. In the long-term, average ABG improved by 2.3 dB in PORPs and 13.4 dB in TORPs. PORPs had higher rates of ABG closure and lower AC PTAs than TORPs in the long-term. DiscussionEndoscopic ossiculoplasty is a viable option in children presenting with ossicular erosion from various causes. Audiometric improvement following endoscopic partial and total ossicular reconstruction remains stable over time, with a preference towards partial in the long-term, and mirrors published outcomes for microscopic surgery.

Can the unmodified incus be used for a simpler, more cost-effective functional ossicular chain reconstruction? A retrospective clinical study.

To evaluate patients' hearing outcomes after ossicular chain reconstruction using unmodified autologous incus. A single-centred, retrospective study of patients who underwent incus interposition between June 2010 and October 2017 was conducted at a Dutch secondary referral centre. This paper describes a chart review of patients who presented with erosion of the long process of the incus due to atelectasis or cholesteatoma who were treated with an unmodified incus interposition. The main outcome measures were: post-operative air-bone gap and level of air-bone gap closure. Thirty-three ears of 32 patients were included. Follow-up duration ranged from six weeks to seven years. A mean post-operative air-bone gap under 25 dB was considered successful; this was achieved in 25 patients (76 per cent), 20 (91 per cent) in the partial ossicular reconstruction prosthesis group and 5 (45 per cent) in the total ossicular reconstruction prosthesis group. This difference was statistically significant (p = 0.007). Successful preservation and improvement of hearing was observed in most patients. As expected, the closure rate in the partial ossicular reconstruction prosthesis group was better. Longer follow-up studies with larger case numbers are needed to assess whether further reconstruction techniques are necessary.

Incus Autograft Partial Ossicular Reconstruction Prosthesis vs. Titanium Angular Clip Prosthesis in Patients with Incudostapedial Joint Erosion Caused by Chronic Otitis Media; A Randomized Clinical Trial.

Chronic otitis media (COM) is a common disease that can cause damage to the middle ear ossicles and thus lead to conductive hearing loss. The purpose of this study was to compare two methods of incus partial ossicular reconstruction prosthesis (PORP) and reconstruction with titanium angular clip prosthesis in patients with incudostapedial joint erosion. In this interventional randomized clinical trial carried out in a tertiary referral hospital, patients with chronic otitis media and incudostapedial joint erosion who were candidates for surgery, were randomly allocated into two groups of incus PORP surgery and reconstruction with a titanium angular clip prosthesis. Audiometry was performed for the patients prior to and six months after surgery. Pre- and post-operative air-bone gap (ABG) and bone conduction (BC) thresholds were calculated and means were compared by analysis of variances (ANOVA). A P value of <0.05 was considered statistically significant. The study consisted of 24 and 14 subjects in the incus PORP and angular clip groups, respectively. There was no statistically significant difference between the mean pre- and post-operative ABG, BC thresholds and ABG reduction in the compared groups. Considering issues such as high cost and inaccessibility of titanium angular clips in all centers, incus PORP may be a more acceptable method.

Single centre experience of ossiculoplasty using different materials: a subjective and objective evaluation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media has serious impact over the ossicular integrity in middle ear resulting in ossicular necrosis and various grades of hearing loss along with other associated symptoms. Tympanomastoidectomy with ossicular reconstruction using various materials can improve the symptoms.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study of 50 patients underwent tympanomastoidectomy with ossiculoplasty in Department of ENT and Head and Neck Surgery at AIIMS Patna from April 2017 to 2018. Patients with chronic otitis media having ossicular necrosis with ABG (air bone gap) more than 25 dB were included in this study. PORP (partial ossicular reconstruction prosthesis) and TORP (total ossicular reconstruction prosthesis) were used as ossicular reconstruction after clearance of disease. This study was expressed as subjective and objective evaluation following ossiculoplasty. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Fifty patients having chronic otitis media with decreased hearing and other associating symptoms were included in this study. Preoperative air conduction threshold was 55.32 dB with preoperative ABG was 44.24 dB. Postoperative result was summarised as postoperative AC threshold was 32.72 dB with gain of 22.60 dB with ABG 25.45 dB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Chronic otitis media may lead to ossicular necrosis and various grade of hearing loss. A proper technique and skilled tympanomastoidectomy with ossiculoplasty can improve the symptoms of chronic otitis media.&lt;/p&gt;

Effect of a boomerang-shaped Conchal cartilage graft for Type three Tympanoplasty on Hearing.

Introduction Chronic suppurative otitis media atticoantral disease (CSOM-AAD) is often associated with ossicular erosion resulting in significant hearing loss. Absence of the stapes suprastructure is a poor prognostic indicator of hearing outcome, which necessitates an effective reconstruction technique for ossicular continuity and restoration of middle ear volume. In the present study, we used a boomerang-shaped conchal cartilage graft. Objective To evaluate the improvement in hearing using a boomerang-shaped conchal cartilage graft for Type III tympanoplasty in cases of CSOM-AAD in which the stapes suprastructure was absent and to study the incidence of intraoperative/postoperative complications of this procedure. Method A total of 21 patients with CSOM-AAD who were found to have absent stapes suprastructure intraoperatively were included. A boomerang-shaped conchal cartilage graft was placed over the stapes footplate for reconstruction following canal wall down mastoidectomy. Pure tone audiogram (500, 1,000, 2,000 and 4,000 Hz) was done preoperatively and at 12 weeks postoperatively. Hearing outcome and incidence of complications were noted. Results There was a statistically significant reduction in the hearing loss for air conduction and air-bone gap (ABG) of 6.1 dB and 6.9 dB respectively ( p < 0.05). Air-bone gap < 30 dB could be achieved in 71.4% of the patients as compared with 23.8% preoperatively. No significant difference was noted in the bone conduction threshold (p > 0.05). A better hearing outcome was observed at higher frequencies (2,000, 4,000 Hz). No major complications were encountered. Conclusion A boomerang-shaped conchal cartilage graft is effective when used for Type III tympanoplasty, especially at higher (2,000, 4,000 Hz) frequencies, and is comparable to newer materials such as titanium total ossicular reconstruction prosthesis (TORP). No major intraoperative/postoperative complications were noted.

Pediatric ossiculoplasty: optimizing outcomes.

Despite years of research, pediatric ossiculoplasty remains a challenging surgery with numerous variables factoring into successful outcomes. The aim of this review is to summarize recent publications on surgical technique, timing, and reconstruction materials. The cause behind ossicular discontinuity does not seem to play a role in hearing results after ossiculoplasty; however, revision surgery is associated with worsening outcomes. The status of the ossicles remains an active area of interest, but the data remain mixed in terms of them playing a role in predicting outcomes in adults and pediatric patients. There remains debate regarding the utility of staging the reconstruction and is often undertaken on a case-by-case basis. Other recent publications highlight positive outcomes associated with canal wall-up procedures, titanium prostheses, and partial ossicular reconstruction prostheses. Endoscopic middle ear surgery in ossiculoplasty has been shown to be successful in monitoring and removal of disease and helpful in reconstruction. Pediatric ossiculoplasty remains a challenging yet rewarding procedure. The bulk of publications are retrospective making much of the literature difficult to interpret. There remains a need for prospective and well controlled studies in both adult and pediatric populations.

Total and partial ossiculoplasty in children: Audiological results and predictive factors

ObjectiveTo assess ossiculoplasty results in children and screen for predictive factors of efficacy. Patients and methodsSeventy five children undergoing ossiculoplasty between 2001 and 2014 in a pediatric ENT department were included. The following data were collected and analyzed: demographic data, surgical indication, history of tympanoplasty, contralateral ear status (healthy, affected), preoperative hearing thresholds, surgical technique, intraoperative findings, and ossicular chain status at eardrum opening. Audiological results were reported according to American Academy of Otolaryngology-Head and Neck Surgery guidelines. ResultsForty eight patients were included in the total ossicular reconstruction prosthesis (TORP) group. Mean age at surgery was 9.9years. Mean follow up was 2.7years. Mean air-bone gap (ABG) closure to within 20dB was achieved in 40% of cases at medium term (12 to 18 months after surgery). Air conduction (AC) threshold ≤30dB was achieved in 68% of cases. AC threshold improved by 14.6dB and 8.7dB at medium and long-term follow-up, respectively. A significant correlation was found between success rate and absence of history of tympanoplasty. The success rate was higher for primary than for revision procedures. Twenty seven children were included in the partial ossicular reconstruction prosthesis (PORP) group. Mean age was 9.5years, and mean follow-up 2.6years. Mean air-bone gap (ABG) closure to within 20dB was achieved in 75% of cases at medium term. AC threshold ≤30dB was achieved in 75% of cases AC threshold improved by 9.3dB and 5dB at medium and long-term follow-up, respectively. No predictive factors for success were found in the PORP group. ConclusionThe present study suggested that total ossiculoplasty leads to better results when performed in first-line. It also confirmed that functional outcome is better in partial than total ossicular reconstruction prosthesis.

Comparative study of autologous incus, tragal cartilage and partial ossicular reconstruction prosthesis (PORP) in ossiculoplasty

Comparative study of autologous incus, tragal cartilage and partial ossicular reconstruction prosthesis (PORP) in ossiculoplasty

Revision stapedectomy with bone cement: are results comparable to those of standard techniques?

To examine hearing results in revision stapedectomy using hydroxyapatite bone cement for incus necrosis. Retrospective case series. Tertiary care academic medical center. Eligible patients underwent revision stapedectomy for otosclerosis using hydroxyapatite bone cement to reconstruct incus necrosis between March 2007 and August 2013. Patients were excluded for insufficient audiometric data or an operative indication other than otosclerosis. Revision stapedectomy performed with standard stapes piston prostheses using hydroxyapatite bone cement to stabilize the prosthesis. Air-bone gap (ABG), air-conduction and bone conduction pure-tone audiometry thresholds, and speech discrimination scores (SDSs) were obtained preoperatively and postoperatively. The preoperative result closest to the date of surgery was compared with the postoperative result farthest from the date of surgery. Twenty-seven patients (aged 32-83 yr) met criteria and were included in the study. Average duration of follow-up was 7 months (range, 1-39 mo). Postoperative closure of the ABG to within 10 dB was achieved in 77.8% of cases. Closure to within 20 dB was achieved in 96.3%. The average postoperative ABG was 8.1 dB (range, 0-24 dB). The average SDS change was +7.4% (-12% to +92%). There were no cases of significant postoperative sensorineural hearing loss by bone conduction pure-tone audiometry. Use of hydroxyapatite cement for treatment of incus necrosis in revision stapedectomy provides excellent hearing outcomes and is a reasonable alternative to total ossicular reconstruction prosthesis or malleovestibular prosthesis techniques.

Hearing Outcomes after Revision Stapedectomy Managed with Total Ossicular Reconstruction Prostheses

Objectives: (1) Describe the use of total ossicular reconstruction prostheses (TORP) during revision stapedectomy in the setting of advanced incus erosion. (2) Analyze the short- and medium-term audiometric results of TORP for revision stapedectomy. Methods: A retrospective case review at a tertiary neurotological referral center was conducted of nineteen cases of revision stapedectomy where TORP reconstruction was performed due to advanced incus erosion. Pre- and postoperative bone conduction (BC-PTA) and air conduction (AC-PTA) pure tone averages (0.5, 1, 2, 3 kHz) including high tone bone conduction (1, 2, 3 kHz), air-bone gap (ABG), and speech discrimination scores (SDS) were measured. Short-term (3 weeks) and medium-term (median, 12 months) hearing outcomes were measured. Results: Among 19 ears undergoing revision stapedectomy managed with TORP reconstruction, the average number of previous revision attempts was 1.2 (SD, 2; range, 1-6). The preoperative BC-PTA was 32.1 dB preoperatively while the preoperative AC-PTA was 65.3 dB. The mean postoperative ABG significantly decreased to 16.6 dB (SD, 13.68; range, −2.5 to 46.3 dB, P &lt; .003) with mean follow-up of 15 months (SD, 18.8; range, 0.75-54 months). A nonsignificant mean high tone BC-PTA decrement of 3.8 dB (SD = 5.9, range −8.33 to 18.33 dB, P = .427) was observed including one ear with no responses postoperatively. No further revisions were noted in follow-up. Conclusions: Total ossicular reconstruction in the setting of previous revision stapedectomy with limited incudovestibular reconstructive options may lead to favorable hearing outcomes but carries an increased risk of sensorineural hearing loss.

Total Ossiculoplasty

Review experience using a titanium TORP with a footplate shoe; compare early and long-term hearing results and complications with those obtained using a TORP alone. Retrospective chart review. Tertiary referral neurotologic private practice. Patients undergoing total ossicular replacement with a titanium prosthesis (total ossicular reconstruction prosthesis [TORP]); 74 with a TORP + footplate shoe and 62 with TORP alone. Ossicular chain reconstruction with a titanium TORP. Short- and long-term air-bone gap (ABG), change in ABG from preoperative to postoperative and from postoperative to last recorded follow-up, sensorineural hearing loss. The shoe group had a smaller mean postoperative ABG (17.7 dB versus 21.6 dB, p ≤ 0.048) and a greater average amount of closure in ABG (21.9 dB versus 13.2 dB, p ≤ 0.004), but there was no significant difference in percentage of patients achieving a postoperative ABG of 20 dB or lesser (57.4% versus 61.6%). There were no differences between groups at long-term follow-up or in amount of change in ABG from postoperative to last audiogram or in amount of change in sensorineural hearing from preoperative to postoperative. Although surgical factors (number of previous surgeries, and presence of a cavity) impacted outcomes, there were no interactions with prosthesis group and no differences in complications between groups. Ossicular reconstruction still presents challenges. A titanium prosthesis with a "shoe" for stabilization may offer advantages. Results in this study consistently favored the TORP + shoe group,although not all differences achieved statistical significance. A larger study might better define possible advantages of the shoe prosthesis for specific subgroups of patients.

연골을 이용한 방패형 제3형 고실성형술의 임상적 유용성

Background and Objectives: Many types of cartilage tympanoplasty have been used in various middle conditions effectively. The purpose of this study is to evaluate the efficacy of type III cartilage shield tympanoplasty. Subjects and Methods: We adopted a carvum conchal cartilage shield tympanoplasty for 3 cases of cholesteatoma, 6 adhesive otitis media, and 6 chronic otitis media of near-total perforation. Malleus handle was medialized but intact before surgery in all the 15 cases. For the hearing outcome evaluation, we set control group of conventional type III tympanoplasty with cartilage capping partial ossicular reconstruction using partial ossicular reconstruction prosthesis. Air-bone gap (ABG) was compared between the study group and control group before and after surgery, and postoperative neo-drum status and complication was evaluated. Results: None of the study ears showed reperforation or any complication at minimum 9 months of follow-up. Two cases were found to have anterosuperior partial retraction of neo-drum. The average ABG was 27.2±9.4 dB preoperatively and 19.0±11.6 dB postoperatively in study group, and 39.58 ± 18.92 dB preoperatively, 20.76±21.36 dB postoperatively in control group. No statistical difference of ABG was found between study and control group (p&gt;0.05). Conclusions: Cartilage shield type III tympanoplasty was safe and effective in high risk of failure group such as large perforation, atelectasis, adhesive otitis media, and cholesteatoma with medialized malleus. (J Clinical Otolaryngol 2013; 24:50–55)

Preliminary Hearing Results of Tympanomastoidectomies Using Titanium Prostheses: Scenario in a Developing Country

The study was done to review postoperative hearing gain of patients with different Middle Ear Risk Index (MERI) undergoing Tympanomastoidectomies with titanium prostheses reconstruction. A Retrospective chart review was performed from September 2009 to December 2011. Of the 17 cases, 9 had moderate MERI while 8 had severe MERI. 9 patients underwent Tympanomastoidectomy with Total Ossicular Reconstruction Prostheses (TORP) and 8 with Partial Ossicular Reconstruction Prostheses (PORP). Hearing gain of 25.31 dB was achieved in cases with moderate MERI compared to 29.37 dB in severe MERI. Less than 20 dB average air-bone gap was achieved in 75% of PORP and 77.77% of TORP reconstructions. In developing countries with limited resources, decision regarding ossicular reconstruction should be made taking into account MERI, intra operative findings and type of surgery. Best results are achieved in cases of CWD with TORP and ICW with PORP.

Titanium ball joint total ossicular replacement prosthesis – Experimental evaluation and midterm clinical results

During reconstruction of the ossicular chain, there is a need to address the forces and loads caused by the ambient atmospheric pressure variations and the resulting tympanic membrane movements. It is understood that when a rigid middle ear prosthesis is inserted the malleoincudal joint, a keyfactor in controlling pressure variations in the middle ear space is bypassed. In this paper we describe a modified total titanium ossicular replacement prosthesis with an innovative micro ball joint in the headplate which is designed to compensate for tympanic membrane movements caused by atmospheric pressure variations. The characteristics of this modified prosthesis were examined in temporal bone experiments and compared to the standard titanium total ossicular reconstruction prosthesis. Sound-induced stapes footplate movements were investigated by means of a Laser vibrometer and revealed no significant differences between the two prostheses in vitro. Intraoperatively, the insertion of the modified prosthesis required more delicate handling. The angle between the shaft and the headplate was variable and ranged from 60 to 90° as estimated by the surgeon. Twelve consecutive patients were eligible for clinical evaluation. The pure tone average (PTA) air-bone gap after a mean follow up period of 32 months was 18.8 dB. Furthermore, no extrusion, dislocation or other adverse events were observed. We conclude that the modified total ossicular replacement prosthesis with integrated micro ball joint yields similar volume velocities of the stapes footplate in the laboratory experiments compared to the standard rigid prosthesis. The audiological and morphological results are encouraging and show that the mobile prosthesis headplate adjusting to the level of the tympanic membrane is a further step in the development of a physiological middle ear implant.This article is part of a Special Issue entitled “MEMRO 2012”.

Usefulness of Cone-Beam Computed Tomography in Determining the Position of Ossicular Prostheses

Cone-beam computed tomography (CT) is proving useful in various operative settings. We hypothesize that it has great potential as an intraoperative assessment tool for ossicular prosthesis positioning. Results from prosthetic ossiculoplasty are frequently disappointing. Undetected intraoperative displacement of the prosthesis may be caused, and obscured, by placement of an overlying cartilage graft. A cadaveric right temporal bone was prepared with a tympanomeatal flap, and an extended posterior tympanotomy through a cortical mastoidectomy. Each of 3 commercially available prostheses was positioned in 3 different locations: (1) optimal, (2) grossly displaced, and (3) marginally displaced. The intended prosthetic positions were confirmed by endoscopy before and after cone-beam CT image acquisition. The primary outcome measure was the position of the prosthesis in relation to the stapes and tympanic membrane, as assessed by 5 expert reviewers blinded to the study. Secondary outcome measures included optimal dosing for adequate image resolution and radiographic scatter associated with different prosthetic materials. Cone-beam CT accurately demonstrated the position of ossicular reconstruction prostheses with respect to the stapes and tympanic membrane. Prosthesis displacement, whether minimally or marked, was also accurately demonstrated. Interobserver agreement among the 5 reviewers, measured using a Fleiss κ statistic, ranged from 0.4 to 0.8 (fair to substantial agreement depending on type and position of the prosthesis). Cone-beam CT is a useful tool for determining the position of ossicular reconstruction prostheses in situ. We suggest it has potential for intraoperative assessment, to check positioning after the prosthesis has been covered with a cartilage graft and tympanomeatal flap.

Clip Vibroplasty

To describe an active auditory rehabilitation method (clip vibroplasty) for conductive or mixed hearing loss in cases of a preserved stapes superstructure. After temporal bone experiments, the new clip vibroplasty was clinically used in 4 patients with chronic otitis media. A new titanium double clip device (clip vibroplasty) was developed for a standardized and effective coupling of the floating mass transducer of the Vibrant Soundbridge to the intact stapes. Temporal bone experiments using laser Doppler vibrometry were performed to evaluate the device's acoustic efficiency. The audiologic outcomes of the first 4 patients were analyzed. The subjective benefits and satisfaction were assessed using the standardized International Outcome Inventory for Hearing Aids in all patients. Transfer characteristics of laser Doppler vibrometry experiments; audiologic outcomes of the 4 patients. In the temporal bone experiment, coupling of the FMT using the titanium double clip support produced transfer characteristics across all tested frequencies comparable to our former total ossicular reconstruction prosthesis or an optimal round window application. The intraoperative application of the clip vibroplasty was uneventful in all cases. No signs of prosthesis dislocation were noted within the follow-up period of approximately 12 months. The audiologic outcome of the first patients showed good hearing gain in pure-tone and speech audiometry, with results that are unobtainable using a conventional air conduction hearing aid. The concept of a partial ossicular reconstruction prosthesis vibroplasty using a titanium clip support entails a straightforward procedure similar to a classic partial ossicular reconstruction prosthesis tympanoplasty. The unoccluded ear canal and the superior auditory performance offer an advantageous application of this "power clip" in cases of chronic middle ear dysfunction.

A Micro-Computed Tomographic Study

To examine the anatomical relationship of the angles between tympanic membrane and stapes footplate and the variation of these angles among different temporal bones in order to characterize the optimal shape of total ossicular reconstruction prostheses (TORPs). Ten specimens of human temporal bones were prepared for examination with micro-computed tomography. Five of the 10 temporal bones were implanted with 3 types of TORPs before subjecting them to micro-computed tomography. The angles between tympanic membrane and stapes footplate were determined. The contact of the TORPs to these structures was assessed. The angle between the stapes footplate and the tympanic membrane was, on average, 25.9 degrees in a plane along the transverse axis of the stapes footplate and 24.6 degrees in a plane along the longitudinal axis of the stapes footplate. Consideration of these angles in TORPs resulted in an optimal contact with the tympanic membrane and stapes footplate, especially for prostheses with a large foot. TORPs should be adjusted in shape before insertion into the middle ear. Further developments should consider prostheses with preadjusted angles or appliances for the exact modification of the prostheses during surgery.

Ossicular Chain Reconstruction Using Titanium versus Hydroxyapatite Implants

Compare the efficacy of total and partial ossicular chain reconstruction using hydroxyapatite (HA) implants versus titanium (Ti) implants. Case series with chart review. Academic tertiary referral center and private practice. 404 patients underwent ossiculoplasty using either Ti or HA implants from June 1996 to September 2008. Patient data were collected retrospectively from the senior author's electronic database of surgical cases. The change in air-bone gap (ΔABG) (defined as the difference between the means of preoperative and postoperative ABG) was 9.9 dB for the HA group that received partial ossicular reconstruction prosthesis (PORP), 9.5 dB for the Ti PORP group, 12.3 dB for the Ti group that received total ossicular reconstruction prosthesis (TORP), and 10.0 dB for the HA TORP group. There was no statistically significant difference between the HA and Ti groups. There was no significant difference in hearing results between canal wall up (CWU) and canal wall down (CWD) cases in which mastoidectomy was performed. Four confounding factors (preoperative otorrhea, preoperative perforation, cholesteatoma, mastoidectomy performed) were analyzed using regression analysis. In the Ti PORP group, the presence of cholesteatoma was found to have a significant negative bias for hearing results. No statistically significant differences in hearing results were found between the HA and the Ti partial and total ossiculoplasty prostheses. No outcome difference was found between CWU versus CWD mastoidectomy groups for any type of implant used. A randomized, prospective study is necessary for a more definitive comparison of efficacy between HA and Ti OCR implants.

Are postoperative hearing results better with titanium ossicular reconstruction prostheses?

Are postoperative hearing results better with titanium ossicular reconstruction prostheses?

Are postoperative hearing results better with titanium ossicular reconstruction prostheses?

Soler ZM, Smith TL. (2009) What is the Role of Long-Term Macrolide Therapy in the Treatment of Recalcitrant Chronic Rhinosinusitis? The Laryngoscope DOI: 10.1002/lary.20549. Morris LGT, Myssiorek D. (2009) When is Surgery Indicated for Asymptomatic Primary Hyperparathyroidism? The Laryngoscope DOI: 10.1002/lary.20560. Zeitler DM, Lalwani AK. (2009) Are Postoperative Hearing Results Better with Titanium Ossicular Reconstruction Prostheses? The Laryngoscope DOI: 10.1002/lary.20573. The above articles, published online July 1, 2009, have been retracted by agreement between the authors, the Journal Editor-in-Chief, Jonas Johnson, and John Wiley & Sons, Inc. These retractions have been agreed as the articles were incorrectly formatted for Early View publication and inaccurately represent The Triological Society's Trio BP article series. These articles will be reformatted for publication in the November issue of The Laryngoscope, and will be given new DOI numbers.