Partial Ossicular Replacement Prosthesis Research Articles

Integration of 3D-printed middle ear models and middle ear prostheses in otosurgical training

BackgroundIn otosurgical training, cadaveric temporal bones are primarily used to provide a realistic tactile experience. However, using cadaveric temporal bones is challenging due to their limited availability, high cost, and potential for infection. Utilizing current three-dimensional (3D) technologies could overcome the limitations associated with cadaveric bones. This study focused on how a 3D-printed middle ear model can be used in otosurgical training.MethodsA cadaveric temporal bone was imaged using microcomputed tomography (micro-CT) to generate a 3D model of the middle ear. The final model was printed from transparent photopolymers using a laser-based 3D printer (vat photopolymerization), yielding a 3D-printed phantom of the external ear canal and middle ear. The feasibility of this phantom for otosurgical training was evaluated through an ossiculoplasty simulation involving ten otosurgeons and ten otolaryngology–head and neck surgery (ORL-HNS) residents. The participants were tasked with drilling, scooping, and placing a 3D-printed partial ossicular replacement prosthesis (PORP). Following the simulation, a questionnaire was used to collect the participants' opinions and feedback.ResultsA transparent photopolymer was deemed suitable for both the middle ear phantom and PORP. The printing procedure was precise, and the anatomical landmarks were recognizable. Based on the evaluations, the phantom had realistic maneuverability, although the haptic feedback during drilling and scooping received some criticism from ORL-HNS residents. Both otosurgeons and ORL-HNS residents were optimistic about the application of these 3D-printed models as training tools.ConclusionsThe 3D-printed middle ear phantom and PORP used in this study can be used for low-threshold training in the future. The integration of 3D-printed models in conventional otosurgical training holds significant promise.

Otolaryngology Implants Usage and their Material Adverse Event Profile - A Narrative Review

Objectives:The objective of this study is to review various biomaterials or implants used in ENT and their adverse effects on events that were noticed from the initial days to the present era.Methods:Relevant articles were searched from the databases. PubMed, Scopus, Web of Science, and Google were used to search for the data.Results:Cochlear implant (CI) adequacy depends on biocompatibility, anti-inflammatory treatment, and reduction of fibrosis. Silicone is used in the otologic field, and its allergy is a rare cause of CI extrusion. Nitinol pistons are used in stapedotomy, and polyethylene (Teflon) grafts are used in partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP). Their complications include graft extrusion and residual perforation. Chronic sphenoid sinusitis is associated with Medpor porous polyethylene implants used for sellar reconstruction in skull-based surgeries. In vocal cord paralysis, injectable collagen preparations form submucosal deposits and dysphonia. Montgomery T-tubes are used in subglottic stenosis, and they produce granulation tissue. Metallic tracheostomy tubes cause the formation of secondary foreign bodies, and biofilms appear in double-lumen tracheostomy tubes.Conclusion:Even though several research studies have been carried out, still a modification of implant design is needed to minimize the complications and to further promote the quality of life of patients.

Predictors of hearing outcomes in patients undergoing ossicular chain reconstruction in a developing country.

Objective: To explore the social and clinical factors that predict audiometric outcomes in patients undergoing ossicular chain reconstruction. Methods: A retrospective analytical cohort study was conducted, including patients 18 years of age or older with a history of chronic otitis media (COM) and/or any of its complications, who underwent ossicular chain reconstruction with Partial Ossicular Replacement Prosthesis (PORP) or Total Ossicular Replacement Prosthesis (TORP), at Hospital San José and Hospital infantile Universitario de San José between 2012 and 2020. We excluded patients with ossicular chain malformations and those with incomplete information. Information about sociodemographic and clinical factors was collected. Additionally, the surgery findings information was analyzed using the Ossiculoplasty outcome parameter staging ( OOPS) index. Results: A total of 35 adult patients who underwent ossicular chain reconstruction were retrospectively studied. An improvement was evidenced in the Preoperative Pure-Tone Average (PTA) and postoperative PTA (p-value=0.036), as well as in the pre and postoperative air-bone gap (ABG) (p-value < 0.01). A moderate correlation coefficient was found between the OOPS index and the postoperative PTA (p= 0.429), and between the OOPS index and the postoperative (ABG) (p= 0.653). Conclusion: We found that a higher OOPS score is correlated with worse hearing outcomes postoperatively, and there was no association between the demographic or pathologic factors with a worse postoperative hearing outcome. Therefore, OOPS index can predict audiometric outcomes in patients undergoing ossicular chain reconstruction in a developing country, regardless of the demographic or pathologic factors.

Analysis of the effect of reconstructing the ossicular chain under otoendoscopy with and without a stapes superstructure

Background Numerous studies have been conducted on the effect of the stapes superstructure after ossicular chain reconstruction, but the findings are not uniform. Objective To compare the hearing outcomes of ossicular chain reconstruction with partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) under otoendoscopy. Materials and methods The records of 111 patients diagnosed with chronic suppurative otitis media were retrospectively analyzed. These patients were divided into PORP group (n = 57) and TORP group (n = 54). They were further subdivided into subgroups PORP-a (with a malleus handle) and PORP-b (without a malleus handle), subgroups TORP-a and TORP-b. Pre- and postoperative audiometric results were analyzed. Results The mean postoperative air conduction hearing thresholds improvement, mean air–bone gap improvement, and the success rate of reconstruction were significantly higher in the PORP group than in the TORP group (p < .05). The mean postoperative air conduction hearing thresholds improvement and the success rate of reconstruction were significantly higher in the PORP-a group than in the TORP-a group (p < .05); and similar results were concluded in comparison of the PORP-b group and the TORP-b group. Conclusions and significance The stapes superstructure has an important positive effect on the postoperative outcome of endoscopic ossicular chain reconstruction.

Extrusion and Dislocation in Titanium Middle Ear Prostheses: A Literature Review.

Titanium middle ear (ME) prostheses are widely used in surgical practice due to their acoustic properties. However, they present a significant drawback shared by all synthetic materials currently in use for ME reconstruction: they can be rejected by the organism of the host. In this study, we aim to review the current literature on titanium partial ossicular replacement prostheses (PORPs) and total ossicular replacement prostheses (TORPs) extrusion and dislocation. Eighty articles were analysed after a full article review based on the inclusion and exclusion criteria. The most common indication for reconstruction was chronic otitis media with cholesteatoma. The average extrusion or dislocation rate was 5.2%, ranging from 0 to 35%. The average improvements in the air-bone gap were 12.1 dB (1.6 dB to 25.1 dB) and 13.8 (-0.5 dB to 22.7 dB) for the PORP and TORP groups, respectively. The data reported on this topic are highly variable, demonstrating that functional outcomes are difficult to predict in clinical practice. We believe that the current limitations could be overcome with technological developments, including bioengineering research focused on promoting prosthesis adaptation to the ME environment.

Feasibility of 3D-printed middle ear prostheses in partial ossicular chain reconstruction.

Despite advances in prosthesis materials, operating microscopes and surgical techniques during the last 50 years, long-lasting hearing improvement remains a challenge in ossicular chain reconstruction. Failures in the reconstruction are mainly due to inadequate length or shape of the prosthesis, or defects in the surgical procedure. 3D-printed middle ear prosthesis might offer a solution to individualize treatment and obtain better results. The aim of the study was to study the possibilities and limitations of 3D-printed middle ear prostheses. Design of the 3D-printed prosthesis was inspired by a commercial titanium partial ossicular replacement prosthesis. 3D models of different lengths (1.5-3.0 mm) were created with Solidworks 2019-2021 software. The prostheses were 3D-printed with vat photopolymerization using liquid photopolymer Clear V4. Accuracy and reproducibility of 3D printing were evaluated with micro-CT imaging. The acoustical performance of the prostheses was determined in cadaver temporal bones with laser Doppler vibrometry. In this paper, we present an outline of individualized middle ear prosthesis manufacturing. 3D printing accuracy was excellent when comparing dimensions of the 3D-printed prostheses and their 3D models. Reproducibility of 3D printing was good if the diameter of the prosthesis shaft was 0.6 mm. 3D-printed partial ossicular replacement prostheses were easy to manipulate during surgery even though they were a bit stiffer and less flexible than conventional titanium prostheses. Their acoustical performance was similar to that of a commercial titanium partial ossicular replacement prosthesis. It is possible to 3D print functional individualized middle ear prostheses made of liquid photopolymer with good accuracy and reproducibility. These prostheses are currently suitable for otosurgical training. Further research is needed to explore their usability in a clinical setting. In the future, 3D printing of individualized middle ear prostheses may provide better audiological outcomes for patients.

Audiologic results of total ossicular replacement prosthesis bypassing the stapes suprastructure in canal wall down mastoidectomy

ObjectivesSometimes performing PORP adequately is challenging when the stapes is tilted or the suprastructure is partially damaged owing to inflammation or infection. In such cases, the implementation of a TORP bypassing the stapes can be a useful alternative. This study aimed to investigate whether bypassing the stapes suprastructure during total ossicular replacement prosthesis (TORP) affects postoperative complications or audiological outcomes. Material and methodsAmong 104 patients who underwent open cavity mastoidectomy and ossiculoplasty using a titanium prosthesis at Korea University Ansan Hospital between January 2012 and December 2019, we compared the preoperative and postoperative audiological results and surgical complications of 52, 21, and 31 patients who underwent partial ossicular replacement prosthesis (PORP), TORP bypassing the remaining stapes suprastructure, and TORP on the stapes footplate or oval window, respectively. ResultsThe air-bone gap before surgery was significantly different in the TORP on the stapes footplate group (34.2 ± 12.0 dB) than that in the PORP (22.9 ± 13.8 dB) and TORP bypassing the stapes groups (20.7 ± 11.5 dB, p < 0.001). After surgery, there were no significant differences among the groups (p = 0.818). The air-bone gap difference before surgery was associated with the presence of stapes before surgery (p < 0.001). There was no difference in the proportion of postoperative tympanic perforation, whether it was a revision surgery, malleus status, or the size of perforation of the tympanic membrane among the three groups. ConclusionWhen performing ossiculoplasty using TORP, bypassing the stapes did not affect surgical and audiologic outcomes.

Comparative Analysis of the Hearing Effects of Partial Ossicular Replacement Prosthesis Versus Conchal Cartilage in Canal Wall Down Mastoidectomy with Type II Tympanoplasty: A Retrospective Case Review Study.

To investigate the effects of titanium partial ossicular replacement prosthesis (PORP) and conchal cartilage for ossiculoplasty on hearing results in single-stage canal wall down (CWD) mastoidectomy surgery with type II tympanoplasty in patients with cholesteatoma. The patients were performed surgeries for the first time by a senior otosurgeon from 2009 to 2022 and were performed CWD mastoidectomy with type II tympanoplasty in one stage were enrolled. Patients who could not be followed up were excluded. Titanium PORP or conchal cartilage was used for ossiculoplasty. When the stapes head was intact, a cartilage 1.2-1.5mm thick was attached directly to the stapes; when the head of the stapes was eroded, a 1mm high PORP and cartilage of .2-.5mm thick were placed on the stapes simultaneously. 148 patients were included in the study in total. The titanium PORP and conchal cartilage groups showed no statistically significant differences at 500, 1000, 2000, and 4000Hz considering the number of decibels of closure of the air-bone gap (ABG) (P > .05) and pure-tone average ABG (PTA-ABG) (P > .05). Meanwhile, the closure of PTA-ABG between the 2 groups showed no statistically significant differences in the overall distribution (P > .05). For patients with cholesteatoma and mobile stapes who underwent CWD mastoidectomy with type II tympanoplasty in one stage, either PORP or conchal cartilage is a satisfactory material for ossiculoplasty.

Which is Better for Ossiculoplasty Following Tympanomastoidectomy: Polycel® or Titanium?

The purpose of this study was to compare the surgical outcomes of Polycel® and titanium in ossiculoplasty following tympanomastoidectomy (TM). A total of 221 patients underwent ossiculoplasty following TM by a single surgeon using either Polycel® or titanium as prosthesis. Hearing was tested preoperatively and postoperatively at 6 months by pure-tone audiometry. Successful surgery was defined if postoperative air-bone gap (ABG) was <20 dB, the gain in air conduction (AC) hearing was >15 dB HL, or postoperative AC was <30 dB HL. Multiple linear regression was conducted to identify the factors associated with the surgical outcomes. In canal wall up mastoidectomy (CWUM), both Polycel® and titanium showed favorable successful rates if partial ossicular replacement prosthesis (PORP) was used (64.3% of Polycel® and 67.6% in titanium). If total ossicular replacement prosthesis (TORP) was used, both represented similar outcomes (54.5% of Polycel® and 75.0% in titanium). In canal wall down mastoidectomy (CWDM), significant ABG reductions were observed only in the titanium group (5.2 ± 14.7 dB of Polycel® [P = .083] and 7.0 ± 14.2 dB of titanium [P = .002] in PORP; 4.6 ± 13.5 dB of Polycel® [P = .097] and 9.5 ± 11.2 dB of titanium [P < .001] in TORP). In multivariate analysis, titanium had a positive effect on the reduction of postoperative AC thresholds (B: -4.772; 95% CI: -8.706--0.838). Both Polycel® and titanium showed favorable surgical outcomes for ossiculoplasty following CWUM. Titanium prosthesis is recommended for surgery after CWDM.

Effects of preloads on middle-ear transfer function and acoustic reflex in ossiculoplasty with PORP

IntroductionSurgical outcomes in ossiculoplasty with partial ossicular replacement prostheses (PORPs) are greatly influenced by the amount of preload imposed on the PORP. In this study, the attenuation of the middle-ear transfer function (METF) was experimentally investigated for prosthesis-related preloads in different directions, with and without concurrent application of stapedial muscle tension. Different PORP designs were assessed to determine functional benefits of specific design features under preload conditions. MethodsThe experiments were performed on fresh-frozen human cadaveric temporal bones. The effect of preloads along different directions were experimentally assessed by simulating anatomical variance and postoperative position changes in a controlled setup. The assessments were performed for three different PORP designs featuring either a fixed shaft or ball joint and a Bell-type or Clip-interface. Further, the combined effect of the preloads towards the medial direction with tensional forces of the stapedial muscle was assessed. The METF was obtained via laser-Doppler vibrometry for each measurement condition. ResultsThe preloads as well as the stapedial muscle tension primarily attenuated the METF between 0.5 and 4 kHz. The largest attenuations resulted from the preload towards the medial direction. The attenuation of the METF with stapedial muscle tension was reduced with concurrent PORP preloads. PORPs with a ball joint resulted in reduced attenuation only for preloads along the long axis of the stapes footplate. In contrast to the clip interface, the Bell-type interface was prone to lose coupling with the stapes head for preloads in the medial direction. ConclusionsThe experimental study of the preload effects indicates a direction-dependent attenuation of the METF, with the most pronounced effects resulting from preloads towards the medial direction. Based on the obtained results, the ball joint offers tolerance for angular positioning while the clip interface prevents PORP dislocations for preloads in lateral direction. At high preloads, the attenuation of the METF with stapedial muscle tension is reduced, which should be considered for the interpretation of postoperative acoustic reflex tests.

Comparison of partial vs. total ossicular chain reconstruction using titanium prosthesis: a retrospective cohort study.

Comparison of the hearing outcomes of titanium partial ossicular replacement prosthesis (PORP) vs. titanium total ossicular replacement prosthesis (TORP) with footplate shoe (Omega Connector) in second stage ossicular chain reconstruction surgeries. In this retrospective cohort study in a tertiary hospital, we compared the hearing outcomes in 248 patients who had undergone ossicular chain reconstruction with titanium prostheses PORP (n = 115) vs. TORP (n = 133) from August 2017 to June 2021. Pre-and post-operative audiometric data were assessed. In general, we found that there were no significant differences between PORP and TORP groups in gains of BC (P = 0.080), AC (P = 0.454), ABG (P = 0.928), SRT (P = 0.065), and SDS (P = 0.363). There were no significant differences in terms of ABG gain between the two groups. Regarding ABG gains frequency-specific analysis in the ears with pre-operative conductive hearing loss, there were no significant differences between low-frequencies (P = 0.260) and high-frequencies (P = 0.973) between the two groups. To sum up, this research provided additional evidence with respect to hearing outcomes after staged ossicular chain reconstruction with PORP and TORP. The practical application of our study is that TORP with footplate shoe (Omega Connector) is comparable with PORP in staged ossiculoplasty.

Hearing outcomes after incudo-stapedial rebridging versus partial ossicular replacement prosthesis in chronic suppurative otitis media

Aim: To evaluate the early postoperative hearing results after Incudo-stapedial rebridging versus partial ossicular replacement prosthesis application in cases of incudo-stapedial discontinuity due to chronic suppurative otitis media.Study Design: A prospective randomized comparative clinical trial.Place and Duration of Study: Otolaryngology Department, Tanta University, Egypt from January 2018 to June 2021.Methodology: Inclusion criterion was cases with CSOM with ABG more than 30 dB and adequate cochlear reserve. Study population were sixty consecutive cases with incudo-stapedial erosion more than 2-millimeter gap. Thirty of them were candidates for incudo-stapedial rebridging using tragal cartilage strip graft and glass ionomer bone cement. The other thirty patients were candidates for PORP. Tympanoplasty was done for each case of the two groups.Main Outcome Measures: hearing assessment following surgical procedures.Results: Postoperative air conduction significantly decreased compared to baseline in each group. By comparing the results of both techniques, pre and postoperative air conduction were insignificantly different.ABG significantly decreased postoperatively compared to baseline in each group. By comparing between both techniques, pre and postoperative ABG were insignificantly different.Conclusions: Among chronic suppurative otitis media patients with ossicular erosion, our study showed that PORP and cartilage graft with glass ionomer bone cement effectively improved hearing levels when used for the reconstruction of the incudostapedial joint during tympanoplasty.

A Partial Ossicular Replacement Prosthesis With a Concentric Ball Joint in the Headplate.

In passive middle ear prosthetics, rigid implants have proven successful in reconstructing the ossicular chain. However, these cannot fully replicate the physiology of the ossicular chain. Pressure fluctuations cause high stresses in rigid passive prostheses, which can result in dislocation, protrusion, and pre-tension in the annular ligament resulting in unsatisfactory hearing results. In collaboration with MED-EL, we developed a new passive middle ear prosthesis that features a balanced, centered ball joint between the headplate and shaft of the prosthesis. We compared the sound transmission properties of this new prosthesis with those of a standard rigid prosthesis. Using Laser-Doppler-Vibrometry, we measured the sound-induced velocity of the stapes footplate relative to a given acoustic stimulus. The new prosthesis showed equivalent sound transmission characteristics compared to the rigid prosthesis, whereas retaining the ability to compensate for pressure fluctuations due to its ball joint. This ensures good transmission properties even during displacements of the tympanic membrane. This development is a further step toward a physiological reconstruction of the ossicular chain. NA Laryngoscope, 133:1717-1721, 2023.

Functional Outcomes of Single-Stage Ossiculoplasty in Chronic Otitis Media With or Without Cholesteatoma.

Background:Two-stage ossiculoplasty has been widely used for hearing improvement in chronic otitis media with or without cholesteatoma. However, the outcomes of single-stage ossiculoplasty have not been fully clarified.The aim of this study is to determine whether the outcomes of single-stage ossiculoplasty are comparable with those of 2-stage ossiculoplasty in chronic otitis media with or without cholesteatoma.Methods:Medical records of 191 cases (187 patients) who underwent single-stage ossiculoplasty from January 2011 to May 2018 at our hospital were retrospectively reviewed.Results:Polycel and titanium were used in 56 and 135 cases, respectively. In chronic otitis media without cholesteatoma, the success rate of polycel and titanium partial ossicular replacement prosthesis was 80.7% and 81.6%, respectively. In chronic otitis media with cholesteatoma, the success rate of polycel and titanium partial ossicular replacement prosthesis was 63.6% and 64.6%, respectively, while that of polycel and titanium total ossicular replacement prosthesis was 45.9% and 47.8%, respectively.Conclusion:These results suggest that single-stage ossiculoplasty is a suitable option for recovering postoperative hearing in chronic otitis media with or without cholesteatoma. Thus, if middle ear inflammation can be sufficiently treated in the first stage, single-stage ossiculoplasty is a suitable option for chronic otitis media with or without cholesteatoma.

Audiometric Outcomes Comparing Endoscopic Versus Microscopic Ossiculoplasty.

To assess endoscopic and microscopic ossiculoplasty audiometric outcomes. Retrospective review. Tertiary academic center. Adult patients who underwent ossiculoplasty with either partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) from 2010 to 2019 with at least 1 year of audiometric follow-up were included. Endoscopic or microscopic ossiculoplasty. Postoperative air-bone gap (ABG) after at least 1 year. A total of 198 patients, 53.5% female, and a median age of 47.5 years, met inclusion criteria. 64.1% of patients were reconstructed with a PORP, and 31.8% were reconstructed using an endoscopic approach. The median audiometric follow-up was 27 months. The median postoperative ABG was 16.9 dB overall, 15.6 dB for PORP reconstruction, and 19.4 dB for TORP reconstruction (PORP versus TORP, p = 0.002). For TORP reconstructions, the median ABG for both endoscopic and microscopic TORP was 19.4 dB ( p = 0.92). For PORP reconstructions, the median ABG for endoscopic PORP was 12.3 dB compared with 16.3 dB for microscopic PORP ( p = 0.02). Using multivariate linear regression to predict postoperative PORP ABG, and controlling for age, prior ossiculoplasty, middle ear mucosal disease (granulation, fibrosis, polyposis), middle ear atelectasis, myringitis, contralateral middle ear disease, and use of byte prostheses, endoscopic PORP reconstruction was associated with improvement in ABG over the microscopic approach by 4.4 dB ( p = 0.04). For PORP ossiculoplasty procedures, endoscopic ossiculoplasty is associated with improved postoperative ABG compared with microscopic ossiculoplasty.

Optical Clearing Agents for Optical Imaging Through Cartilage Tympanoplasties: A Preclinical Feasibility Study.

Optical clearing agents (OCAs) can render cartilage tympanoplasty grafts sufficiently transparent to permit visualization of middle ear structures in an operated ear using optical coherence tomography (OCT) imaging. Pieces of human tragal cartilage were treated with glycerol, a commonly used OCA. A reference reflector was imaged with OCT through the tympanoplasty as it cleared and the optical attenuation of the graft was measured. The reversibility of clearing and the dimensional changes associated with glycerol absorption were also measured. In a separate experiment, a human cadaveric temporal bone was prepared to simulate an ossiculoplasty surgery with cartilage replacement of the tympanic membrane. A partial ossicular replacement prosthesis (PORP) inserted in the ear was imaged with OCT through a 0.4mm cartilage graft optically cleared with glycerol. The optical attenuation of 0.4mm cartilage grafts decreased at 2.3+/-1.1 dB/min following treatment with glycerol, reaching a total decrease in attenuation of 13.6+/-5.9 dB after 7 minutes. The optical and dimensional effects of glycerol absorption were reversable following saline washout. In the temporal bone preparation, treatment of a cartilage graft with glycerol resulted in a 13 dB increase in signal-to-noise ratio and a 13 dB increase in contrast for visualizing the PORP through the graft with OCT. Optical clearing agents offer a potential pathway towards optical coherence tomography imaging of the middle ear in post-surgical ears with cartilage grafts.

A comparison of sound transmission of middle ear prostheses manufactured via SLM

Middle ear surgeries involve Total Ossicular Replacement Prosthesis (TORP) or Partial Ossicular Replacement Prosthesis, where all or some of the three ossicle bones are replaced. Current prostheses are dissimilar to the natural ossicles in geometry, size and only recover up to 75% sound transmission. Additive manufacturing offers complex, near-net shape geometries that allow for patient specific implants. A novel design is used to manufacture a TORP in Ti6Al4V(ELI) via Additive Manufacturing. The sound transmission level of the of the additively manufactured titanium prosthesis was measured by laser doppler vibrometry and compared to that of a Silver additively manufactured prosthesis. The sound transmission level of the additively manufactured prostheses are also compared to that of the international standards and literature using this method.

Correlation of intraoperative middle ear status and hearing results in single-stage canal wall down tympanomastoidectomy with PORP\u2014a prospective study

BackgroundMastoidectomy is one of the common surgical procedures performed by the otologist. It is commonly done for cholesteatomatous chronic otitis media (CCOM) and can be performed as either canal wall up or down techniques. Most of the CCOM is associated with ossicular erosions which require ossicular chain reconstruction (OCR) which can be done either in one stage or multiple stages.A multitude of factors affects postoperative OCR results with tympanomastoidectomy. Among various factors, the status of the tympanic membrane and middle ear mucosa is quite essential. To date, there are no randomized or prospective studies assessing the integrity of pars tensa and status of the middle ear mucosa in hearing outcomes in single-stage tympanomastoidectomy using partial ossicular replacement prosthesis (PORP) in the literature. Therefore, this study is performed to correlate the integrity of pars tensa and middle ear mucosa condition with postoperative hearing results of single-stage canal wall down (CWD) tympanomastoidectomy with PORP.ResultsForty-two patients with cholesteatomatous chronic otitis media underwent single-stage canal wall down mastoidectomy (CWD) and partial ossicular replacement prosthesis (PORP) placement. The statistical analysis was done to compare the results of postoperative hearing with the intraoperative integrity of pars tensa and middle ear mucosa status. The mean pre- and postoperative air-bone gaps (ABGs) of all cases were 23.9 dB and 21 dB, respectively, with no statistically significant difference. In the pars tensa intact group, the mean pre- and postoperative ABGs were 21.5 dB and 18.5 dB, respectively, and in the pars tensa not intact group, the mean pre- and postoperative ABGs were 25.7 dB and 22.8 dB, respectively, and both groups had statistically insignificant difference. The pre- and postoperative ABGs in the healthy middle ear mucosa group were 20.7 dB and 19 dB, respectively. Similarly, the pre- and postoperative ABGs in non-healthy middle ear mucosa were 24.4 dB and 21.2 dB, respectively. The differences were not statistically significant in both groups.ConclusionThere was a statistically significant improvement in postoperative air conduction threshold (ACT) in all cases. The integrity of pars tensa and middle ear mucosa status did not affect the postoperative hearing outcome in single-stage CWD tympanomastoidecomty using PORP.

Combination of Direct Oval Window Vibroplasty With Customized Partial Ossicular Replacement Prosthesis (PORP): A Novel Reconstruction Technique to Rehabilitate Mixed Hearing Loss.

Hearing rehabilitation with an active middle ear implant (AMEI) in patients with mixed hearing loss (MHL) after multiple ear surgeries is surgically challenging and requires individual solutions in some cases. Our objective was to introduce a feasible novel technique for direct oval window vibroplasty (OW vibroplasty) using a partial ossicular replacement prosthesis (PORP) to ensure stability and enable active and passive sound transmission. Four patients with MHL following multiple middle ear surgeries and indication for an AMEI received direct OW vibroplasty in combination with a customized PORP between the enwrapped actuator and reconstructed tympanic membrane (TM). Postoperative bone conduction was stable in all patients. All patients benefitted from the AMEI in combination with PORP with a mean functional gain of 31.5 ± 17.0 dB. Mean aided postoperative pure tone average was 27.3 ± 2.6 dB. Speech discrimination in quiet at 65 dB with the German Language Freiburg Monosyllabic Test improved for all patients to 68.8 ± 6.3% and in noise with the German Language Oldenburger Sentence Test to -10.4 ± 3.3 dB SNR. No complications were observed. This novel technique of direct OW vibroplasty extends the portfolio of reconstructive middle ear procedures by combining an intraoperatively customized "off-the-shelf" PORP as a coupler between floating mass transducer (FMT) and a cartilage TM. We found satisfying functional hearing results. Benefits of the reported technique comprise 1) stabilization and optimized coupling of the reconstruction, 2) possibility of passive sound transmission, 3) general feasibility due to great availability of a regular PORP, and 4) flexibility in bridging of large gaps between TM and actuator.

Isolated Traumatic Dislocation of the Malleus into the External Auditory Canal.

We report a rare case of isolated malleus dislocation into the external auditory canal with lateralized intact tympanic membrane following a head trauma. The patient was a 63-year-old woman who presented at the outpatient department of our institute with hearing loss of 10 years' duration after a bicycle accident. During physical examination of the patient, total dislocation of the malleus-like bony structure into the external auditory canal on the right side was observed. In the computed tomography scan, an isolated malleus dislocation with intact incus-stapes articulation was identified. The patient was successfully treated with endoscopic exploratory tympanotomy and partial ossicular replacement prosthesis. The isolated malleus dislocation can rarely occur after trauma. A careful diagnostic step through history, physical examination, and temporal bone computed tomography scan are needed to confirm this rare condition.