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At least 163 records · Page 9Linked to original sources
PubMed1996

[The results of tympanoplasty with titanium prostheses].

In order to improve the hearing results of tympanoplasty, we performed the operation on 113 cases (124 ears) by using ossicular replacement prostheses made of Titanium. The results demonstrated that among all the operated ears, 73/124 (58.9%) had obtained a narrow gap (< 20 dB HL) between BC and AC, 89/124 (71.8%) had regained socially acceptable hearing ability. The total effective rate of hearing gain (> 10 dB HL) was 115/124 (92.7%). No reject reaction and recurrent cholesteatoma were found. This operation method, based on animal experiments and applied anatomic study of human suprastapedial structure, resulted in a high effective rate and maked hearing improvement with a relatively large magnitude. It was because of the application of a new material-Titanium, which has high biocompatibility with human body tissues. The ossicular replacement prosthesis was appropriately designed and delicately manufactured. It fitted well and could be tightly joined to the suprastapedial structure, and uneasy to be displaced. In addition, we adopted the method of enlarging tympanic isthmus, that lead to well aeration in mastoid and attic, thus set the tympanic membrane to the best state of mobility. All these contributed to the effective hearing gain.

Adolescent↗
PubMed2001

Anterior subannular T-tube for prolonged middle ear ventilation during tympanoplasty: evaluation of efficacy and complications.

OBJECTIVE: We previously described the use of anterior subannular T-tubes (n = 20) for long-term middle ear ventilation. In the current study, we examine a larger patient population (n = 38) and a longer follow-up interval (average >2 years) to evaluate the efficacy and safety of anterior subannular tympanostomy. STUDY DESIGN: Retrospective nonrandomized case review. SETTING: Tertiary referral hospital. PATIENTS: Our series consisted of 38 consecutive patients with a diagnosis of eustachian tube dysfunction, adhesive otitis media, or chronic otitis media with a perforation who underwent a tympanoplasty. INTERVENTION: A subannular T-tube was placed anteriorly at the time of tympanoplasty to provide long-term middle ear ventilation. MAIN OUTCOME MEASURES: The main outcomes of this study are tube position, tube patency, and middle ear ventilation. In addition, hearing was evaluated both preoperatively and postoperatively and any complications were noted. RESULTS: There were 38 patients and 38 ears that received an anterior subannular T-tube at the time of tympanoplasty. The study group consisted of 24 female patients and 14 male patents with a median age of 36 years (range, 10-75 yr). All 38 patients had eustachian tube dysfunction, 22 had adhesive otitis media, 23 had chronic otitis media, 13 had a cholesteatoma, 11 had tympanic membrane perforations, and 3 patients had a cleft palate. All patients underwent tympanoplasty. Eighteen patients had a concomitant ossiculoplasty and 7 had a mastoidectomy. Follow-up ranged from 1 month to 48 months (average, 26 mo). Three tubes had extruded within 2 years, in 1 case resulting in a persistent perforation. Postoperative complications included 1 patient with a partially extruded prosthesis, 2 patients with tipped prosthesis and persistent tympanic membrane retraction, and 1 patient with a plugged tube. All other tubes were patent and showed no evidence of migration. Furthermore, there were no cases of anterior canal blunting or ingrowth of epithelium around the tube. CONCLUSION: Anterior subannular tympanostomy is a safe and effective method for long-term middle ear ventilation in patients with chronic eustachian tube dysfunction.

Adolescent↗
PubMed2006

Malleus-stapes assembly: experience with two prostheses.

Tympanoplasty is often a necessary part of middle-ear surgery, the most common defect being that between an intact, mobile stapes and the malleus handle. The most readily available tissue is the patient's incus, reshaped to bridge the space between an intact stapes and the malleus. When the incus cannot be used, the hydroxyapatite Wehrs incus prosthesis can be used as an alternative.Twenty-six patients had an autograft incus ossiculoplasty and 20 patients underwent modified Wehrs incus prosthesis ossiculoplasty. The average post-operative air-bone gaps (ABGs) were 16.2 dB hearing loss (dBHL) and 17.2 dBHL, respectively. Air-bone gap closure to within 15 dBHL was achieved for 48 per cent of incus autografts and for 57 per cent of Wehrs prostheses, and to within 20 dBHL for 77 per cent and 62 per cent, respectively. Over four years follow up, the reconstruction was stable for each group, the ABGs being 17.7 dBHL and 17.1 dBHL, respectively.

Chronic Disease↗
PubMed1999

Inner ear damage in TORP-operated ears: experimental study on danger from environmental air pressure changes.

In some cases of sudden inner ear hearing loss in ears with a total ossicular replacement prosthesis, the prosthesis has been found to be penetrating the footplate. Some authors have assumed an external pressure increase for this event. In this study I tried to estimate experimentally the pressure needed for perforating a normal footplate in a temporal bone model. From the data I concluded that "cracking" the footplate can hardly be due to 1 major event of increased pressure. On the other hand, different mechanisms making the footplate a "weak spot" must be discussed and further investigated. In those cases, secondary to thinned or even perforated footplates, environmental pressure changes may be dangerous.

Air Pressure↗
PubMed2001

[Hyperacusis after tympanoplasty].

A case of hyperacusis after tympanoplasty is presented. A 62-year-old woman experienced unilateral conductive hearing loss for about 60 years after antrotomy in infancy. Neurological or otoneurological symptoms were not evident. Tympanotomy showed a missing incus with discontinuity of the chain. Reconstruction was performed by interposition of a partial ossicular replacement prosthesis (PORP). The postoperative audiogram revealed minimal perceptive hearing loss in the high-frequency field in the operated ear. Several weeks after middle ear surgery, the patient complained of hyperacusis on the operated side, which persisted for more than 2 years. To alleviate the unpleasant sensations, an ear plug was used by the patient. In spite of the asymmetric hearing loss, no late onset auditory deprivation could be diagnosed. The pathophysiological causes of the hyperacusis have not yet been clarified. Possible reasons are discussed.

Audiometry, Pure-Tone↗
PubMed2003

[How do metallic middle ear implants behave in the MRI?].

BACKGROUND: Magnetic resonance imaging (MRI) has gained in frequency and importance as a diagnostic procedure. In respect to the close anatomical relationship in the temporal bone it is necessary to know whether it is hazardous to patients with metallic middle ear implants regarding displacement and rise in temperature. For the MR image quality artefacts caused by metallic prostheses should be low. METHODS: Four different stapes prostheses made from titanium, gold, teflon/platinum and teflon/steel, a titanium total ossicular reconstruction prosthesis (TORP) and two ventilation tubes (made from titanium and gold) were tested in a 1.5 Tesla MRI machine regarding their displacement. All objects were first placed in a petri dish, then suspended from a thread and finally immersed in a dish filled with Gadolinium. Temperature changes of the implants were recorded by a pyrometer. RESULTS: None of the implants moved when they were placed in the petri dish or suspended from the thread. On the water surface the teflon/platinum and the teflon/steel pistons adjusted their direction with their axis longitudinally to the MRI scanner opening and the teflon/steel piston floated towards the MRI-machine when put close enough to the scanner opening. No rise in temperature was recorded. All implants showed as little artefacts that would still make an evaluation of the surrounding tissue possible. CONCLUSION: Patients with any of the metallic middle ear implants that were examined in this study may undergo MRI-investigations without significant adverse effects.

Artifacts↗
PubMed2002

Evolving acoustic characteristics of the canal wall down cavities due to neo-osteogenesis by periosteal flap.

OBJECTIVE: To determine whether the acoustic properties of the canal wall down cavity would come closer to those of the normal ear canal as the cavity is lined with periosteal flap. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Twenty one subjects who underwent canal wall down mastoidectomy and total ossicular replacement prosthesis tympanoplasty were selected. INTERVENTIONS: Canal wall down cavities were lined with postauricular periosteal flap. The acoustic properties of 21 canal wall down cavities (mastoidectomy ears) and 16 contralateral normal ears (control ears) were measured with a hearing aid fitting system. MAIN OUTCOME MEASURES: Frequency, amplitude, bandwidth, and Q factor of the resonance curve along with the loss in amplitude below 1 kHz were compared in a paired-wise manner between the first and third months and the third and sixth months postoperatively in mastoidectomy ears, and also between mastoidectomy and control ears. RESULTS: In the mastoidectomy ears, the peak resonance frequency and bandwidth significantly increased at the end of the third and six months as the volume of the cavity decreased ( < 0.05). However, the amplitude and Q factor of the resonance curve remained stable. At the end of the first month, all parameters were different in both groups ( < 0.05). At the end of the sixth month, the frequency and bandwidth of the resonance curve in both groups were not different. The mastoidectomy ears had some decibel-amplitude loss below 1 kHz. Only its frequency changed as the cavity became smaller ( < 0.05). CONCLUSIONS: New bone formation facilitated by a periosteal flap in the posterior part of the CWD cavity behind the facial ridge may provide acoustic properties similar to those of the normal ear canal.

Acoustic Impedance Tests↗
PubMed2005

Malleus-to-footplate versus malleus-to-stapes-head ossicular reconstruction prostheses: temporal bone pressure gain measurements and clinical audiological data.

HYPOTHESIS: Several clinical reports suggest that if the stapes superstructure is intact, ossicular reconstruction should be made to the stapes head rather than the footplate to achieve a better hearing outcome. To test this hypothesis, we compared the in situ mechanical performance of hydroxylapatite (HA) malleus-to-stapes-head (MSH) ossicular reconstruction prosthesis (ORP) with malleus-to-footplate (MFP) ORP, both manufactured by Project HEAR. BACKGROUND: ORPs are commonly used to replace a missing or deficient incus. However, hearing outcomes are highly variable, depending on the ORP material, design, surgical technique, and ORP positioning. METHODS: Cochleo-vestibular pressure measurements in human cadaveric temporal bones for the HA MFP ORP have been reported by Puria et al. (2005). In the present study, the ear canal pressure Pe and cochleovestibular pressure Pv were measured in cadaveric temporal bones with intact incus, removed incus, and MSH ORP reconstruction. The relative loss in gain, Lmsh, is defined as the ratio of Pv with reconstructed MSH ORP to intact incus and compared with Lmfp. A retrospective clinical audit of the pre- and postoperative audiologic results of patients who had undergone ossiculoplasty with either MSH or MFP ORP was conducted for comparison. RESULTS: For the 0.5 to 3 kHz frequency range, Lmsh magnitude is 6.2 dB lower than the Lmfp magnitude (p = 0.05). The retrospective audit of audiologic results after ossiculoplasty with either MSH or MFP ORP revealed a similar difference in gain between the two ORP designs with air-bone gap differences of 7.6 dB (p = 0.04) and air conduction threshold differences of 8.0 dB (p = 0.13) for these patients. CONCLUSION: The MFP ORP showed better average pressure gain compared with the MSH ORP across the speech frequencies. Surgeons performing ossiculoplasty with designs similar to Project HEAR HA ORPs, where there is direct columella-like connection between the malleus and stapes, should consider using the MFP ORP design to achieve a better postoperative audiologic result, even when the stapes superstructure is intact.

Aged↗
PubMed1991

Ossicular chain reconstruction: a combined prosthesis with organic and synthetic material.

The surgical techniques to restore the sound pressure transfer mechanism in surgery of chronic otitis media are still in an evolutionary stage. Ossicular interposition is effective and certainly is not controversial. The use of various organic prostheses has been criticized. The prosthesis with a shaft of Teflon and a homograft bone flange is an alternative method which has been successful in our hands.

Bone and Bones↗
PubMed2004

A new L-shaped titanium prosthesis for total reconstruction of the ossicular chain.

OBJECTIVE: To describe the technique used for total ossiculoplasty with the Fisch titanium total prosthesis and evaluate the 1-year postoperative functional results in patients presenting with the stapes (or footplate) without the malleus handle. STUDY DESIGN: Prospective trial with preoperative and postoperative comparison. SETTING: Academic and private practice tertiary care center for otologic surgery. PATIENTS: Forty-nine consecutive patients operated on from September 1996 to December 2000. SURGERY: : Staged ossicular reconstruction with a Fisch titanium total prosthesis placed between the footplate and the tympanic membrane without regard to the presence or absence of the stapes arch. Coupling of the prosthesis to the footplate was achieved by various techniques, including perforation, foot and spike on the footplate without perforation, and shaft alone (without foot) with tragal cartilage fixation (disc or small wedges). There was no interposition of cartilage between the prosthesis head and the tympanic membrane. MAIN OUTCOME MEASURES: Pre- and postoperative air and bone-conduction thresholds and air-bone gaps for pure-tone averages of three and four frequencies and for single frequencies. RESULTS: Postoperative air-bone gap closures within 20 dB distributed equally (50%) between 0.5, 1, and 4 kHz and reached the highest rate (89%) at 2 kHz (p < 0.05). The postoperative air-bone gaps for pure-tone averages reached 0 to 20 dB in 57% and 0 to 30 dB in 87% of the cases. There were no dead ears and no partial or total extrusions of prostheses. The best functional results were achieved through perforation coupling of the spiked foot to the footplate in large oval windows and after fixation of the shaft (without foot) with tragal cartilage disc in narrow oval windows. CONCLUSION: The functional results of the L-shaped Fisch titanium total prosthesis implanted in ears with the stapes but no malleus handle are best at 2 kHz and better than those of comparable columellar titanium prostheses over the remaining tested frequencies.

Adult↗
PubMedDate not supplied

Modelling medical devices: the application of bioengineering in surgery.

Medical device technology has an increasingly important role in surgical procedures. In this article, five case studies of bioengineering in surgery are described as follows: computer-aided design of vascular grafts; middle-ear prostheses; hip prosthesis stems for optimal cement pressurisation; prototype development of a device for measurement of abdominal sounds for monitoring digestive tract activity and a hand-access device for laparoscopic surgery. In each case, new bioengineering design methodologies are demonstrated. The general principles underlying the application of bioengineering in surgery are discussed.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

[A experimental device for ultrasonic control of ear ossicle prosthesis function].

A device designed by the author is intended for functional control over prosthetic auditory ossicle efficacy in experiment. The device employs Doppler effect and lies inside the frame adjusted for the experimental conditions. The device provides standard conditions for determining amplitude-frequency characteristics and signal transmission factor in the range 128-2000 Hz. As illustration, measurements of transmission from the T-shape prosthesis are described.

Doppler Effect↗
PubMed2000

Ossiculoplasty using hydroxyapatite prostheses: long-term results.

The surgical results of ossicular chain reconstruction using a hydroxyapatite prosthesis were evaluated in 106 ears of 101 patients who were followed up for > 5 years. Successful reconstruction was defined as: (1) postoperative air-bone gap of </= 20 db; or (2) postoperative air conduction better than 40 db; or (3) hearing gain better than 15 db. Success in hearing was obtained in 63/106 ears (59%) at 1 year; 44/65 ears (68%) in P-type (short columella) and 19/41 ears (46%) in T-type (long columella). By the fifth year, the overall success rate had deteriorated to 50%: i.e. 39/65 ears (60%) in P-type and 14/41 ears (34%) in T-type. Extrusion of the prosthesis occurred in 17 ears (16%) with a mean postoperative period of 27.7 months. The present results indicate that hydroxyapatite is a suitable material for an ossicular prosthesis, although the incidence of extrusion is high when it is placed in contact with the tympanic membrane.

Adolescent↗