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PubMedDate not supplied

[Antibiotic prophylaxis in surgery of uncomplicated cholesteatoma: review of 150 patients].

A review was made of 150 cases of chronic otitis media caused by cholesteatoma that were operated consecutively; no complications or active otorrhea was present. In 61.3% of cases, prophylactic antibiotic (PA) treatment was given on the basis of the surgeon's criteria, which probably reflected the presence or absence of risk factors. Most patients were given a penicillin or penicillin derivative (amoxi-ampicillin followed by cephalosporins). Antibiotic administration was prolonged longer than necessary (mean 3.4 days). PA was not associated with important complications. Postoperative infection occurred in 10.7% of cases, usually infection of the surgical wound, most commonly by Staphylococcus aureus. Otorrhea occurred in 7.3% of cases in the 15 days after surgery and was more frequent in patients treated via an endomeatal approach and in those who had ossicular prosthesis. Prophylactic antibiotic treatment produced no benefit to our patients in the form of any reduction in number of surgical infections, postoperative otorrhea or mean hospital stay. Therefore, PA is not recommended in surgery for uncomplicated cholesteatoma. When risk factors are present, a suitable and complete antibiotic treatment may be indicated.

Adult↗

PubMed2003

Ossiculoplasty with total hydroxylapatite prostheses anatomical and functional outcomes.

OBJECTIVE: To evaluate the results of partial and total ossicular reconstruction prostheses entirely made of hydroxylapatite. STUDY DESIGN: A retrospective review of cases followed-up between 1997 and 2000. SETTING: Tertiary referral center. PATIENTS: One hundred adult patients (60 men and 40 women) were studied. The mean age was 55 years (range, 25 to 65 years). Fifty patients had a previous tympanoplasty. The series included 45 cholesteatomas (45%), 37 chronic otitis media without cholesteatoma (37%), 13 retraction pockets (13%), and 5 posttraumatic ossicular displacements (5%). INTERVENTION: A one-stage ossiculoplasty with a partial ossicular reconstruction prosthesis (n = 65) or a total ossicular reconstruction prosthesis (n = 35) was performed. This was associated with a simple mastoidectomy in 70 cases and a radical mastoidectomy in 10 cases. MAIN OUTCOME MEASURES: All patients were followed-up at 1 year, and 50 were reexamined 2 years after surgery. Clinical and audiometric data were collected in a database at each visit. RESULTS: A prosthetic extrusion was noted in two cases (2%). A prosthetic displacement occurred in 10 cases (10%). A revision surgery was carried out in 10 cases because of an ossiculoplasty failure or a disease recurrence. At 1 year, the residual air-bone gap was lower in cases with a partial ossicular reconstruction prosthesis than those with a total ossicular reconstruction prosthesis (16 +/- 9.3 versus 23 +/- 13.7 dB, p < 0.05). The gain in mean air conduction threshold was 21 +/- 12.8 dB in cases of partial ossicular reconstruction prosthesis and 19 +/- 11.3 dB in cases of total ossicular reconstruction prosthesis (not significant). Revision surgery, canal wall-down mastoidectomy, or cholesteatoma yielded poorer functional results. CONCLUSION: Partial ossicular reconstruction prosthesis and total ossicular reconstruction prosthesis entirely made of dense hydroxylapatite yielded high rates of air-bone gap reduction and high anatomic stability.

Adult↗

PubMed1993

Hearing results with clothespin ossiculoplasty: preliminary report on the Kraus Modified Schuring Ossicle-Cup Prosthesis (Clothespin Prosthesis).

The clothespin partial ossicular replacement prosthesis (PORP) is designed to increase joint stability during incus replacement ossiculoplasty. Fundamental modifications have been made in the Schuring ossicle-cup, which include a forked well, increased well wall thickness and length, and a flexible tip disk added to the shaft. The forked well functions like a straight clothespin rather than an inverted cup. The forked well enables the clothespin prothesis to slide down over the stapes superstructure, between the facial nerve canal and the promontory, to form a stable, mortise-and-tenon prosthesis-stapedial joint. Joint stability is enhanced because the inferior tine of the forked well is able to lever against the inferior surface of the stapes superstructure, creating a counterforce to gravity. This is in contrast to the more unstable ball-and-socket joint created by most partial ossicular replacement prostheses when they articulate with the stapes capitulum. The addition of a flexible disk to the shaft tip produces a tight, stable union between the prosthesis and the ossicular cap by increasing resistance at the shaft-ossicle interface. Fluoroplastic composition maximizes intraoperative versatility and reliability while the ossicle cap minimizes extrusions. One-year hearing results for twelve chronic ear patients with mobile stapes undergoing clothespin ossiculoplasty during intact canal wall tympanomastoidectomy revealed postoperative air-bone gaps within 20 dB in 92% of cases. The mean postoperative air-bone gap was 8.9 dB, and the mean improvement in air-bone gap was 14.4 dB.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1981

[Reconstruction of the ossicular chain: Plastipore prosthesis compared with autogenous and allogenic ossicles (author's transl)].

Morphological and audiological early and late results after reconstruction of the ossicular chain with Plastipore prosthesis (TORP's and PORP's) were compared with those achieved by using autogenous or allogenic ossicles. In particular 32 tympanoplasties with TORP's were compared with 25 cases of columella and 29 PORP cases with 75 interpositions. Only Plastipore prostheses were extruded, up to now in 11.4% of cases. The final extrusion rate will be even higher since perforations of the fascia graft or the drum over the head of the prostheses as signs of imminent extrusions were noted in 9.8% of tympanoplasties at the end of the 2-year follow-up period. However, only in one third of tympanoplasties cartilage had been interposed between the head of the prosthesis and the fascia graft or drum. Audiological results, early as well as late ones, using the mean postoperative air-bone gap as criterion of success, showed no statistically significant differences between the compared groups. Only the comparison of the mean air-bone gaps in late results versus the preoperative values seemed to favour the PORP group over the interposition group. In some PORP cases, however, greater reduction of the air-bone gap was caused by postoperative deterioration of the bone conduction threshold level. In addition, hearing gains were more lasting in the interposition than in the PORP group. Because of the high extrusion rate and the fact that the audiological results were not significantly better than in the compared groups we will cease using PORP's and will employ TORP's only with careful interposition of cartilage and then only in selected cases with good tubal function.

Audiometry↗

PubMed1998

Hearing results with the Dornhoffer ossicular replacement prostheses.

The "ideal" prosthesis for ossicular reconstruction should, from a surgical standpoint, require easy manipulation, reduce surgeries to partial or total variants, and be constructed of stable, biocompatible material. From an acoustic standpoint, a prosthesis should weigh 10 to 40 mg, provide proper tension between the tympanic membrane (TM) and stapes, form less than a 30-degree angle with the TM, and accommodate the malleus. Work was conducted with Smith & Nephew Richards, Inc. (Memphis, TN), to develop a partial ossicular replacement prosthesis (PORP) and a total ossicular replacement prosthesis (TORP) that combined the majority of these features. This retrospective study used a computerized otologic database to identify patients implanted with a Dornhoffer HAPEX PORP or TORP from June 1995 to March 1997. The surgical procedures utilizing these prostheses were primary cholesteatoma and revision surgery of previously performed modified or radical mastoidectomies complicated by poor hearing or chronically draining cavities. Preoperative and postoperative air and bone conduction four-frequency (500, 1000, 2000, and 3000 Hz) pure-tone averages (PTAs) were used to calculate the PTA air-bone gaps (ABGs). Results in 52 cases (follow-up, 1 year) showed a statistically significant improvement in hearing (P < 0.05) for each group. Excellent hearing results (< or = 10 dB PTA-ABG) were seen in 69% of PORP cases and in 35% of TORP cases, and good results (11 to 20 dB PTA-ABG) were seen in 31% and 50% of PORP and TORP cases, respectively. Designing an ossicular replacement prosthesis with both surgical and acoustic factors in mind has led to encouraging short-term hearing results.

Acoustics↗

PubMed1979

[The use of a chondro-metallic prosthesis when the ossicular chain is destroyed (author's transl)].

The author describes a new prosthesis used in functional rehabilitation when the chain is destroyed. It consists of a tripod part in gold, anchored in the attic region with its foot resting on the plate of the stapes. This prosthesis is covered with a piece of autologous cartilage freshly removed from the tragus which forms the junction with the tympanic membrane or covering fascia. 60 cases are presented, some with a follow-up of 4 years. All of the patients were suffering from the sequelae of chronic otorrhoea, with varying degress of destruction of the chain and tympanic membrane, leaving a mobile plate. Functional rehabilitation in one stage was good in 66% of cases, poor in more than 8% of cases and nil in 25% of cases. Tolerance of the prosthesis was comparable to that of other metallic or plastic materials used in the middle ear. The plate of the stapes would appear to tolerate the prosthesis perfectly since no secondary labyrinthisation was seen. The author suggests the use of this chondro-metallic prosthesis was a reliable means of ensuring functional rehabilitation in the presence of a post-otitic empty middle ear.

Cartilage↗

PubMed1995

Plasti-pore implants in middle ear surgery.

Plasti-pore, a high-density polyethylene sponge, was one of the earliest biocompatible materials developed specifically for implantation in the middle ear. It is one of the most nonreactive materials known when tested in simulated biochemical exposure to pseudoextracellular fluid. The two basic prosthetic designs are the total ossicular replacement prosthesis and the partial ossicular replacement prosthesis. Plasti-pore implants have now been used for 20 years and are widely accepted by otologic surgeons. The basic properties of the material, implant design, and surgical techniques involved using these prostheses are reviewed in this article.

Ear Ossicles↗

PubMed2006

[Variable length titanium prostheses for type III tympanoplasty. Intraoperative length adjustment and fixation of the cartilage overlay].

INTRODUCTION: For type III tympanoplasty by partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), the length of the prosthesis must match the individual intraoperative anatomical and physiological characteristics. MATERIALS AND METHODS: Databanks were used to determine the necessary sizer length of the sizer disc. The measurement template for the size of the cartilage to overlay the prosthesis headplate was derived from the headplates of the Tübinger titanium prostheses (TTP) and the Dresdener titanium prostheses. Finally all functions were integrated into a synthetic plate. RESULTS: The result was a simple and reasonably priced disposable multifunctional instrument (Tübinger sizer disc TSD) which allowed an exact measurement for every prosthesis in TORP and PORP. For the TTP-Variac, the TSD enabled the simple intraoperative production of prostheses with the length desired by the surgeon. For PORP the TSD enabled an adaptation of the diameter of the prosthesis foot for TTP, TTP-Vario and TTP-Variac and provided a template for the size determination of the cartilage overlay of the titanium prosthesis head. The sizers and the resulting prostheses were used for initial tympanoplastic operations. Audiometric investigations carried out 6 weeks postoperatively gave results corresponding to those previously obtained in a study with TTP and TTP-Vario using the old instrumentation. CONCLUSIONS: The new instrumentation leads to an improvement of the intraoperative practicability and a simplification. The audiological results remain the same.

Disposable Equipment↗

PubMed2005

Hearing results with the titanium ossicular replacement prostheses.

The purpose was to study the hearing results in patients receiving a Kurz titanium Bell partial ossicular replacement prosthesis (PORP) or an Aerial total ossicular replacement prosthesis (TORP). The study was a retrospective chart review in a tertiary otologic referral center. A computerized otologic database was used to identify 111 patients implanted with either a PORP or TORP prosthesis. Audiograms were reviewed and air-bone gaps were calculated for each patient. The improvement of the average air-bone gap (ABG) was 10.2 and 12.7 dB at 3 and 20 months after ossiculoplasty, respectively. Sixty-six percent of patients (73/111) had a postoperative air-bone gap of 20 dB or less. The ABG for the titanium PORP prosthesis was 14.3+/-9.7 dB, compared with 25.2+/-13.7 dB for the TORP prosthesis (P <0.05). The ABG to within 20 dB or less was obtained in the PORP group in 77% of the cases, versus 52% of the cases in the TORP group (P <0.05). Two extrusions of the prostheses were observed at 17 and 20 months after surgery (1.8%). Revision procedures for functional failure were carried out in 20 patients (18%). The rate of sensorineural hearing loss was 3.6%. The major factors influencing good audiometric results were the surgical procedure preserving the external auditory canal and the presence of the stapes. The best hearing results were achieved when a PORP was used in an intact canal wall (ICW) procedure, and the worst hearing results were achieved when a TORP was used in a canal wall down (CWD) procedure. The titanium Kurz prosthesis has been an effective implant at our institution for ossicular reconstruction.

Adolescent↗

PubMed1997

[Functional surgery of cholesteatoma. I. Closed techniques].

A review was made of 138 ears treated with walled-up canal tympanoplasty for chronic otitis media with cholesteatoma. In 66.7% of the ears, two-stage operations were performed. Cholesteatomas were located in the attic (72.5%), mesotympanum (42.8%), antrum (39.1%), and mastoid (11.6%). The most common lesion of the ossicular chain was incus necrosis (61.6%). Total ossicular replacement prosthesis (TORP) (56.5%), partial ossicular replacement prosthesis (PORP) (21.7%), mastoid cortical bone autograft (13%), and incus autograft (8.7%) were used to reconstruct the ossicular chain. After three years, 56.5% of the operated cars were free of complications. The rest had the following complications: recurrence of cholesteatoma (17.4%), perforation of the neotympanum (12.5%), prosthesis extrusion (9.4%), and episodes of otorrhea (4.2%). The best functional results were obtained with autografts (cortical and incus) and TORP.

Adolescent↗

PubMed2003

Ossicular chain reconstruction: titanium versus plastipore.

OBJECTIVE: To compare the complication rate and hearing results of a new, lightweight, titanium ossicular replacement prosthesis with Plastipore prostheses (Xomed, Jacksonville, FL). STUDY DESIGN: Retrospective. METHODS: Charts were reviewed for type of operation, type of prosthesis used, extrusion rate, prostheses failure rate, and hearing thresholds at multiple frequencies and at multiple follow-up points. The dependant variable for hearing results was the four-frequency average air-bone gap. RESULTS: There were 84 patients undergoing tympanoplasty with the Plastipore prosthesis and 53 with the titanium. There was one extrusion in the titanium group. There was an additional single incidence of prosthesis failure in the titanium group. Overall hearing results were comparable with an air-bone gap average of 19.3 dB in the Plastipore group compared with the titanium group with an air-bone gap of 22.0 dB (P =.08). Sixty percent of patients had a postoperative air-bone gap of 20 dB or less in the Plastipore group. In the titanium group, 45.3% achieved a 20 dB or less postoperative air-bone gap. Plastipore had a lower air-bone gap than the titanium when a canal wall up operation was performed (17.8 vs. 23.9 dB) and tended toward a lower air-bone gap when a total ossicular prosthesis was needed (22 vs. 27 dB) (P <.07). CONCLUSION: The titanium prosthesis is a new ossicular replacement prosthesis that provides excellent visualization during insertion and provides hearing results that are comparable with Plastipore. The Plastipore prosthesis performed better in canal wall up mastoidectomy situations and tended toward better performance when a total ossicular replacement prosthesis was needed.

Adult↗

PubMed2000

An anatomically shaped incus prosthesis for reconstruction of the ossicular chain.

An anatomically shaped incus replica prosthesis has been designed to reconstruct the ossicular chain. A series of in vitro studies on human temporal bones evaluated the acoustic performance of this prosthesis and compared it with a Causse partial ossicular replacement prosthesis (PORP). Pure tones in the frequency range 0. 125-8 kHz stimulated the tympanic membrane at sound pressure levels of 80, 90 and 100 dB. Measurements of the stapes footplate velocity were made with a laser interferometer. The acoustic function of the ossicular chain reconstructed with the incus replica prosthesis was found to be within 10 dB of that of the original intact ossicular chain, when both the upper and lower joints of the implant were rigidly fixed in place. It was shown that a rigid mechanical contact between the ossicular prosthesis and ossicles is a prerequisite for effective sound transmission. The anatomically shaped incus prosthesis gave a 15-dB improvement on the PORP at frequencies below 1.5 kHz.

Acoustic Stimulation↗

PubMed1998

Type IV tympanoplasty revisited.

OBJECTIVE: There has been a great improvement in the material and design of prosthesis used for total ossicular reconstruction in recent years. As a result, the indication for type IV tympanoplasty has become more restricted. The long-term follow-up of type IV tympanoplasties performed by the author is presented. STUDY DESIGN AND SETTING: This is a retrospective study of 31 patients who had type IV tympanoplasties performed by the author at the ear, nose, and throat clinic of a district general hospital. PATIENTS: All the patients had chronic active otitis media with total loss of ossicles that were unsuitable for ossicular reconstruction. INTERVENTION AND MAIN OUTCOME MEASURES: The preoperative and postoperative air and bone conduction thresholds of all the patients who underwent type IV tympanoplasty were measured. RESULTS: Twenty-six percent of the patients had a postoperative hearing level <40 dB and 58% had an air-bone gap <30 dB. The indication for type IV tympanoplasty can be categorized into four groups: severe atelectasis, patients with cleft palate, erosion of the footplate, and surgery on the better-only hearing ear. CONCLUSION: There still is a place for type IV tympanoplasty in modern otology.

Audiometry, Pure-Tone↗

PubMed1985

Computed tomographic evaluation of non-metallic middle-ear prostheses.

Non-metallic middle-ear prostheses, including a plastipore total ossicular replacement prosthesis (TORP) and partial ossicular replacement prosthesis (PORP), a Teflon loop stapes piston, and a Ceravital PORP were used to reconstruct the ossicular chain in formalin fixed cadaver temporal bones. The temporal bones were examined using high resolution, thin-section computed tomographic techniques identical to those used for patient studies. The detail and resolution of the images were comparable with those obtained on standard patient exams. The temporal bones were evaluated to determine the appearance of the prostheses in normal and abnormal positions within the middle ear. The radiologist examined the images without fore-knowledge of the position of the prostheses and was able to accurately identify both normal and abnormal positions. With the proper technique an accurate evaluation of non-metallic middle-ear prostheses is possible by high-resolution computed tomography.

Cadaver↗

PubMed2005

Mediolateral graft tympanoplasty for anterior or subtotal tympanic membrane perforation.

OBJECTIVE: To describe and evaluate the mediolateral graft tympanoplasty for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation. STUDY DESIGN AND SETTING: Retrospective study of 100 patients who underwent the mediolateral graft tympanoplasty at community and tertiary care centers from 1995 to 2001. All patients underwent preoperative and postoperative audiograms. Posterior tympanomeatal flap is elevated same as in the medial (underlay) graft tympanoplasty. Anterior-medial canal skin is elevated down to the annulus. At the annulus, only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial (underlay) to the posterior half of the perforation and lateral (overlay) to the anterior half of the de-epithelialized TM perforation, up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second-layer closure. Patients were followed for at least 6 months. Outcome was considered successful if the TM is intact. RESULTS: There were 3 failures (97% success rate), attributable to a postoperative infection, anterior blunting, and recurrent cholesteatoma, respectively. There was no significant postoperative hearing loss compared with preoperative hearing. More than 70% of the operated ears had hearing improvement of 0-40 dB (0-10 dB in 19% of ears, 11-20 dB in 44%, 21-30 dB in 7%, and 31-40 dB in 4%) even without ossiculoplasty. With ossiculoplasty using either partial ossicular replacement prosthesis (PORP, 15%) or total ossicular replacement prosthesis (TORP, 11%), there were various degree of hearing improvement from 11 to 30 dB. CONCLUSION AND SIGNIFICANCE: The mediolateral graft method is superior to the traditional medial or lateral graft technique for the reconstruction of large anterior or subtotal TM perforation. This new method should help otologic surgeons to improve outcome of tympanoplasty for anterior or total TM perforation. EBM RATING: C-1.

Audiometry, Pure-Tone↗

PubMed1988

[Dentin ossicle prostheses (DOP)--a new concept in replacing the ear ossicles].

The variety of materials used for replacement of the ossicles is proof enough that no single material can satisfy all criteria: availability, mouldability, stability and biocompatibility. The trouble-free availability as well as the excellent mouldability enable the development of a principle of preparation of ossicular replacement prosthesis from homologous dentine. The moulding of the dentine ossicular prosthesis is simple and can be performed with an equipment available at any otologic department.

Bioprosthesis↗

PubMed2006

Short-term results using Kurz titanium ossicular implants.

The efficiency of titanium middle ear prosthesis for ossicular reconstruction in chronic ear disease is investigated in a Scandinavian two-center retrospective study from a Norwegian tertiary otology referral center and a Finnish otology referral center. Retrospective chart reviews were performed for procedures involving 73 titanium prostheses between 1999 and 2004. All patients that underwent surgery including the Kurz Vario titanium prosthesis were included in the study, 38 procedures including the partial ossicular replacement prosthesis (PORP) and 35 procedures including the total ossicular replacement prosthesis (TORP). Mean follow-up was 14 months. The ossiculoplasty was performed alone (29 patients) or in combination with other chronic ear surgery procedures (34 patients). Comparisons of preoperative and postoperative pure tone averages (0.5, 1, 2, and 3 kHz) according to AAO-HNS guidelines are presented, as well as data for different PTA definitions. Otosurgery procedures, complications, revisions, and extrusion rates are reported. A postoperative air-bone gap (ABG) of <or=20 dB was obtained in 77% of the patients, 89% for the Bell (Porp) prosthesis, and 63% for the Arial (Torp) prosthesis. Overall mean pure tone averages improved 20.6 dB with ABG improvement of 19.3 dB. The overall extrusion rate was 5% (4 patients). Titanium prostheses have been easy and fast to handle and effective implants for reconstruction of the ossicular chain. We found no difference between reconstruction with or without cholesteatoma surgery during the same procedure. The combination of CWD and Torp gave significant inferior hearing thresholds as compared to Torp/CWU and Porp/CWD combinations.

Audiometry↗

PubMed1996

Surgical results of tympanoplasty with hokudai-shaped partial and total ossicular replacement prostheses.

The surgical results of tympanoplasty using a ceramic partial ossicular replacement prosthesis (PORP) or a ceramic total ossicular replacement prosthesis (TORP) were analyzed. The present study included 25 ears in 22 patients who underwent tympanoplasty between December 1986 and September 1994 and were followed up for more than 6 months postoperatively. Because the ceramic prosthesis was extruded from 2 of the 25 ears, the surgical results in the other 23 ears were analyzed, Surgical results were assessed according to a criterion that permits comparison with data from around the world. The criterion considers a postoperative airbone gap within 20 dB as a success. According to this criterion, the success rate was 90.9% for PORP, 50.0% for TORP, and 69.6% in total. These results are comparable with those found at other centers.

Adolescent↗