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At least 19 recordsLinked to original sources
PubMed2000

[Functional results in the reconstruction of the ossicular chain in partial or total atrophy of the incus. Comparison between reconstruction using a moulded incus and hydroxyapatite PORP].

Ossicular chain defects modifying sound transmission through the middle ear can be treated with (re)implantation of remodeled autologous o homologous ossicles. In recent years, thanks to improved biocompatibility of the materials on the market, prostheses have been increasingly used in the partial or total ossicular chain reconstruction. The present study evaluates auditory ossicle reconstruction as a result of partial or total atrophy of the incus, comparing the use of the remodeled autologous incus with the use of partial hydroxyapatite prostheses (PORP). The study involved 79 patients of which 59 (74.7%) underwent ossicular chain reconstruction using a remodeled, inverted autologous incus while in the remaining 20 cases (25.3%) a hydroxyapatite prosthesis (PORP) was used. The effectiveness of the ossicular chain was evaluated by comparing pre- and postoperative audiometry and evaluating the average thresholds at frequencies of 0.5, 1, 2 and 3 KHz. The average preoperative audiometric gap (understood as the relationship between the air-bone gap) was 23 dB (Standard Deviation 11.2) while postoperatively it was 11 dB (SD 8.5) (p < 0.0001). Therefore the improvement in the air-bone gap was 12 dB (SD 11) for the overall population: 13 dB (SD 10) in those cases where reconstruction was performed using a remodeled incus and 8 dB (SD 11) when PORP was used. The postoperative cumulative gap between the air and bone pathways fell between 0 and 20 dB in 84% of the total population: 89% of those reconstructed with a remodeled incus and 73% of those using PORP. The middle ear ossicular chain reconstruction was performed using remodeled, inverted autologous incus in those cases where ossicular damage did not compromise its use while prostheses made of a biocompatible material (hydroxyapatite PORP) were reserved for those cases where the incus was absent or severely worn. The results obtained are satisfactory, remained stable in time and reflect the average values reported in the Literature.

Adolescent↗
PubMedDate not supplied

On the statics of malleus and incus and on the function of the malleus-incus joint.

An electromagnetic probe was used for statistical measurements on human temporal bone preparations in the malleus-incus region. When forces of 5 and 10 mN (milliNewton) were applied to certain points, the displacement of the malleus was considerably greater close to the umbo than in the region of the short process. According to the lever laws, a pivot was determined which was situated approximately in the mass centre of malleus and incus if two measuring points were chosen which were situated close to the umbo. The pivot was far outside the mass centre when the measuring points were closer to the head of the malleus. The conclusion was that statistically both auditory ossicles have no fixed pivot; rather, they are in a position to adapt to each oscillation of the tympanum. When forces were applied alternately at the malleus and incus with the same lever arm, a different displacement was measured, varying with the force applied. Greater forces led to more pronounced differences in displacement than did smaller forces. When forces of1 mN and below were applied, no differences in the displacement were ascertained. This shows that the malleus-incus joint was flexible if greater forces were applied. In dynamic terms, we can assume the existence of a protective mechanism about 120 dB.

Ear Ossicles↗
PubMedDate not supplied

Ossicular reconstruction in cases of absent or inadequate incus, congenital malformation of the middle ear and epitympanic fixation of the incus and malleus.

This paper reports on the reconstruction of the sound-conducting system in the middle ear in those ears in which the incus and the stapes suprastructure are either absent or inadequate as after prior otitis media or tympanoplasty. When the incus is inadequate after prior stapedectomy or when the stapes suprastructure and incus are absent in congenital malformations of the middle ear, hearing restoration by ossicular reconstruction can cause problems. In cases in which the malleus head and incus are fixed in the epitympanum with the absence of the stapes suprastructure, the ossicular reconstruction will be complicated, too. In these situations, the Teflon malleus attachment piston can be useful to reconstruct the sound-conducting mechanism of the middle ear. We report our results with the malleus attachment piston in 41 operations over an 8-year period. The hearing results show that a closure of the pure-tone average air-bone gap to within 10 dB was possible in 70.7% (29/41) and to within 20 dB in 87.8% (36/41). A residual air-bone gap of > 30 dB was seen in 3 cases (7.3%). Sensorineural hearing loss (> 10%) did not occur and there was no decline in speech discrimination.

Adolescent↗
PubMed2002

Management of incus dislocation by physiological repositioning of the incus.

Data have been collected prospectively from 11 patients (12 affected ears) with traumatic disruption of the ossicular chain. Isolated dislocation of the incus is the most common finding in our cases, but two had stapes arch features and two had fractures of the tympanic bone. The most common cause of the injuries was a road traffic accident. We describe a technique designed to reposition the incus in its physiological position. This involves a combination of a tympanotomy and a posterior approach to the attic region. The results in five patients (six ears) treated in this way are presented.

Craniocerebral Trauma↗
PubMed1977

[Experiences with incus autografts and preserved incus homografts in ear surgery (author's transl)].

The healing process of free-transplantated incus autografts and preserved homografts in the middle-ear is largely non-irritating. They are suited for sound transmission. Under the osteoinductive influence of the non-vital graft, ingrowing vascular connective tissue of the host differentiates itself in osteoblasts, osteoclasts and chondroblasts. The grafts are revitalised in relation to time. Rarely a marked resorption of preserved incus homografts was noticed in consequence of an antigen-antibody-reaction between the host and the implant which, however, never occurred in autografts.

Antigen-Antibody Reactions↗
PubMed2005

[Comparative results of type II ossiculoplasty: incus transposition versus titanium PORP (Kurz)].

OBJECTIVE: The goal of this study was to compare the anatomical and functional results of two groups of patients having an ossiculoplasty type II, either with the incus, or with a PORP Bell Vario prosthesis (Kurz). MATERIALS AND METHODS: Retrospective study concerning 98 patients having had an ossiculoplasty type II with the incus (Incus group) and 50 patients having received a PORP titanium prosthesis Bell Vario from Kurz (Titanium group). RESULTS: The rate of extrusion was small (1% Incus group and 4% Titanium group). Average preoperative air bone gap of patients who received the Titanium prosthesis was 21.2 dB and 42.8 dB for the incus group. The average postoperative air bone gap was 16.9 dB Titanium group and 25.5 dB Incus group (p < 0.05). The gain was 18.7dB in the Incus group and 4.3 dB in Titanium group (p < 0.05). The difference between pre and post air conduction thresholds in both groups was statistically significant (p < 0.05). The post-op airbone gap was less on 20 dB in 62% of cases (Incus group) and 61% (Titanium group). There was no significant loss of the bone conduction thresholds in each group. CONCLUSION: Audiometric results obtained among patients with an incus transposition are better than those obtained with a PORP Titanium prosthesis. These results are to be appreciated by taking account of the greatest proportion of cholesteatoma and of reoperation in the Titanium group. The PORP titanium Bell Vario prosthesis (Kurz) is a material well tolerated by the middle ear as shown by the low rate extrusion. Its qualities (easy and precise measurement, easy positioning) make a material of choice of it when the patient's incus is not usable.

Adolescent↗
PubMed2003

Incus subluxation and luxation during stapedectomy.

Stapedectomy is a safe surgical procedure used in patients with otosclerosis. However, complications may occur and decrease hearing gain after the operation. The aim of the work was to analyze hearing results in patients with incus subluxation during stapedectomy. In 15 (5%) of 292 patients with otosclerosis, the incus was unintentionally luxated during surgery. In one patient the incus was completely dislocated and malleovestibulopexy with autoincus had to be applied. In 14 stapedectomies the incus was subluxated and though it was pathologically mobile it was held in position by its ligaments. This situation allowed delicate reposition of the incus and insertion of the piston prosthesis on the long incus process. Mean AC threshold improved by 24 dB. Mean ABG improved from 34.6+/-8.3 dB before to 13.1+/-6.3 dB 8 months after stapedectomy (t=9.7; p<0.0001). Ten years after surgery average ABG was 10.6+/-4.4, which means stable hearing result. In 6 patients including the individual with complete incus luxation, postoperative ABG was less than 10 dB. In 9 patients postoperative ABG was between 10 and 15 dB. When the incus is subluxated good hearing results can be expected after insertion of the prosthesis on the repositioned incus.

Adult↗
PubMed2006

Storage of the incus in the mastoid bowl for use as a columella in staged tympanoplasty.

OBJECTIVE: To evaluate whether the incus of the cholesteatomatous ear preserved in the mastoid bowl during the first stage of planned two-stage tympanoplasty can tolerate long-term implantation and be used in ossicular reconstruction during the second stage. METHODS: The study group included 24 ears of 23 patients who underwent staged tympanoplasty for the treatment of middle ear cholesteatoma. At the first stage, after removing the incus to eradicate the middle ear disease, it was returned to the mastoid bowl and stored there until use at the second stage. The average interval between the two stages was 8.3 months (range 6-12 months). RESULTS: The incus was identified in all cases at the second stage: 10 incudes were found to be covered with a thin mucosa layer, 12 were buried in fibrous or granulation tissue, and 2 were joined to the surrounding bone. Residual cholesteatoma was found in six ears, either in the attic (three ears) or tympanic sinus (three ears). It never occurred in the mastoid bowl where the incus had been preserved. In 19 cases, the incus was available as a short columella for ossicular reconstruction. The remaining five cases were reconstructed using a hydroxyapatite ossicle as a long columella, since the stapes superstructure was missing at the second stage. In one case, the stored incus underwent remarkable absorption between stages. CONCLUSION: Preservation of the incus in the mastoid bowl is an effective option in planned two-stage tympanoplasty, when the incus is considered useful for ossicular reconstruction at the second stage.

Cholesteatoma, Middle Ear↗
PubMed2002

Stapes surgery: how precisely do different prostheses attach to the long process of the incus with different instruments and different surgeons?

HYPOTHESIS: The goal of this study was to compare the attachment of stapes prostheses with differently shaped loops to the long process of the incus. BACKGROUND: In stapes surgery, the attachment of the prosthesis to the long process of the incus plays an important role concerning the gain in hearing and the development of late complications such as incus erosion and necrosis. Band-shaped and spiral loops have been developed to achieve a broad, firm attachment to the long process of the incus. During stapes surgery, the view at the prosthesis is restricted, making it impossible to evaluate the effects of the differently shaped loops. METHODS: Gold, steel/Teflon, platinum/Teflon, and two different titanium stapes prostheses were inserted in 30 specially prepared temporal bones by three experienced surgeons using the Fisch technique with the McGee and straight alligator forceps for the crimping of the loops. Photographs were taken with 0- and 70-degree rod lens telescopes at defined views. RESULTS: In all prostheses, a sufficiently firm attachment to the long process of the incus was achieved. The attachment of band-shaped loops proved to be better with the straight alligator forceps. The band-shaped loops showed a better contact with the incus than did the wire loops. However, the broad spiral-shaped loops led to a loss of the perpendicular axis of the piston to the long incus process. CONCLUSION: The geometry of the loop affects the final length of the piston in the vestibule and its angle to the long process of the incus.

Equipment Design↗
PubMed2000

The anatomic relationship between the second genu of the facial nerve and the incus: a high-resolution computed tomography study.

OBJECTIVE: This study defines the three-dimensional location of the posterior-most point of the tympanic segment of the facial nerve (TSFN) relative to the posterior-most point of the short process of the incus, using ultrahigh-resolution computed tomography (CT) of the temporal bone. STUDY DESIGN, SETTING, AND PATIENTS: Included were patients who had been referred for CT of the temporal bone for various reasons other than suspected pathologic conditions of the middle ear. The decision whether to include a patient in the study was based on the referring physician's referral note for the examination. INTERVENTION: All of the patients underwent axial CT of the temporal bone, with consecutive slices of 1.1 mm width and 0.5-mm increments. MAIN OUTCOME MEASURES: The posterior-most point of the short process of the incus was identified on axial CT and was superimposed onto a lower axial slice in which the posterior-most point of the TSFN was identified. Its shortest distance to the TSFN was measured. Afterward, the length of the TSFN that remained posterior to the perpendicular of the posterior-most point of the short process of the incus was measured by measuring the length of TSFN that could be seen posterior to the point of bisection of the line marking the shortest distance between the posterior-most point of the short process of the incus and the FN in the previous measurement. The measurements were performed on 30 normal temporal bones. RESULTS: The shortest distance measured between the posterior-most point of the short process of the incus and the TSFN was, on average, 3.31 mm for all 30 ears (range 2-4.8 mm). The length of TSFN that could be seen posterior to the perpendicular of the most posterior point of the short process of the incus was, on average, 2.70 mm (range 1.80-3.90 mm). CONCLUSIONS: In addition to defining the spatial location of the posterior-most point of the TSFN, this study also offers a practical method by which the surgeon can evaluate, preoperatively, how far medial to the incus and how much posterior to the posterior-most point of the short process of the incus the facial nerve is located.

Adult↗
PubMed2003

Technical refinements and precautions during ionomeric cement reconstruction of incus erosion during revision stapedectomy.

OBJECTIVE: The study describes the technical precautions and short-term hearing results of fast-setting ionomeric cement (SerenoCem) for managing incus erosion in revision stapedectomy. STUDY DESIGN: Observational and retrospective chart review. METHODS: Consecutive patients undergoing ionomeric cement incus reconstruction during revision stapedectomy had surgery on an ambulatory basis in a tertiary care referral center. Main outcome measures included technical details, precautions, and recommendations for handling this new material and 6-week hearing outcomes comparing preoperative and postoperative air-conduction and bone-conduction thresholds. RESULTS: A small amount of ionomeric cement on the tip of otological picks applied to the incus remnant successfully reconstitutes the original length of the long process of the incus. In revision stapedectomy, a crimp-on prosthesis may be placed on the cement-lengthened incus. Six-week postoperative audiograms demonstrated significant closure of the air-bone gap in operated cases. Our experience in a failed case leads us to recommend that the setting time for the cement be increased to no less than 20 minutes as opposed to the manufacturer's recommendation of 10 minutes. Also, revision stapedectomy was more likely to be successful when the prosthesis was placed to the incus remnant and stabilized with cement, rather than placing the prosthesis on the cement itself. CONCLUSIONS: Ionomeric cement permits direct reconstruction of a pathologically shortened incus in revision stapedectomy. Surgeons must be aware of precaution and limitations of this new material. Preliminary results indicate significant hearing improvement with this technique when appropriate precautions are taken.

Adolescent↗
PubMed2004

MRI scanning and incus fixation in vibrant soundbridge implantation.

OBJECTIVE: Presentation of patient data after Vibrant Sound-bridge (VS) implantation/explantation with respect to magnetic resonance imaging (MRI) compatibility and stability of incus fixation of the implant. STUDY DESIGN: In a retrospective case review, we report on two patients who had to be diagnosed by cranial MRI scans after previous implantation of a VS. Moreover, in one of these cases, the incus was removed after explantation of the VS because of a peripheral hearing loss. This enabled a microscopic evaluation of the incus. At the long process of the incus, the floating mass transmitter (FMT) has been fixed for 4 years. SETTING: Tertiary referral center. SUBJECTS: Two patients who fulfilled, at the time of implantation, the criteria for implantation of a VS. RESULTS: In both cases, no demagnetization of the external magnet nor of the FMT were found. Device function after the MRI scans were normal. Pure-tone audiometric thresholds remained unchanged after the MRI scanning and the scanning-related magnetic forces. In both cases, the FMT fixation of the incus was found to be regular. In one case, the fixation was checked by an additional tympanoscopy 1 year after the implantation, and in the other case it was assessed by recording the functional gain of the VS (which was normal) after the MRI scanning. One patient complained about a transient hyperacuity due to the loudness during the MRI scanning procedure. MRI scans showed a blackening of the implant area with spherical distortions of the picture. CONCLUSION: Although MRI scanning (at 1.5 tesla [T]) with the FMT in place did not lead to adverse effects in the two patients, systematic in vitro studies are required to determine a possible magnetization threshold that could impair the VS function when MRI scans are applied in those patients. The microscopically observed erosions of the long process of the incus after 4 years of FMT clamp fixation show similarities to findings after stapes revision surgery. However, this limited experience in one case does not allow us to make conclusions on the long-term stability of the incus fixation.

Audiometry, Pure-Tone↗
PubMed1997

[New methods of type II tympanoplasty in erosion of the long incus process].

Reliable methods of reconstruction of the ossicular chain in the situation of an isolated errosion of the long process of the incus using a tympanoplasty type II have not been available until recently. Instead, the tympanoplasty type III has been generally performed with the interposition of an autologous incus. In this presentation, we are describing two methods for reconstruction of the ossicular chain between the in-situ residing incus and the stapes on the other side so that the direct connection eventually will result in a tympanoplasty type II. In the first case, we used ionomeric cement in a way that features two characteristics: the direct connection between the stapes and the long process of the incus could be achieved as well as an articulation that was created on the head of the stapes. Hence, a too stiff connection between the head of the stapes and the long process of the incus could be avoided. In addition, a new method for precise microapplication of cooled bone cement (IONOCAP LV) with a syringe will be presented. In the second method titanium-gold-angle prostheses have been crimped to the long process of the incus and positioned onto the head of the stapes in the way of an articulation. So far, comparison of the audiological results of those two methods of a tympanoplasty type II reveal in average better results than postoperative conductive hearing thresholds of the conventional tympanoplasty type III. If the achieved results can be reproduced on a larger number of patients, the expected audiological results are likely to resemble those of stapes surgery.

Auditory Threshold↗
PubMed2004

Long-term hearing results of incus transposition.

Incus transposition is an option for reconstructing an ossicular discontinuity. We looked at the long-term outcome (average 9.2 years) in terms of hearing results in patients who had undergone incus transposition. Patients were requested to attend for a pure tone audiogram. Details of their preoperative audiograms were obtained from the patients' case notes. A postoperative air-bone gap of 20 dB or less averaged over four frequencies (0.5, 1, 2, 4 kHz) was considered to be an acceptable result. We found that 70% of patients had an air-bone gap of 20 dB or less and 54% had had cholesteatoma surgery at the time of the incus transposition. This study represents the longest follow-up of patients having undergone incus transposition from our search of the literature. Incus transposition, we feel, offers good long-term hearing results.

Adolescent↗
PubMed2006

Stapes surgery: the diameter of the long process of the incus.

HYPOTHESIS: The aim of this study was to examine the long process of the incus in respect of its shape and its dimensions at the site of the attachment of a stapes prosthesis. BACKGROUND: One of the complications in stapes surgery is the erosion of the long process of the incus at the site of the attachment of the prosthesis, resulting in a fluctuating conductive hearing loss. Knowing the dimensions of the attachment site of the prosthesis at the long process of the incus will make it possible to optimize the size of the prosthesis loop. METHODS: The incus was obtained from 11 patients who had undergone middle ear surgery for hearing improvement or cholesteatoma removal. The ossicles were kept in 4% paraformaldehyde and were processed for histological examination after decalcification in ethylenediamine tetra-acetic acid. The 5-microm slices were stained with toluidine blue and examined in the light microscope. Using digitized video images of the histological slices, the diameters, circumference, and surface of the specimens were determined. RESULTS: The diameter of the long process of the incus at 1.4+/-0.28 mm from the tip, which is the average site of prosthesis attachment, showed an oval shape with a minimum diameter of 0.66+/-0.05 mm, a maximum diameter of 0.81+/-0.1 mm, and a circumference of 2.46+/-0.23 mm. CONCLUSION: The loop of a stapes prosthesis should have the following dimensions: diameter 0.9 mm, loop length of 2.2 mm, and opening of loop 0.7 mm. However, the material of the prosthesis and its malleability are also important factors.

Adolescent↗
PubMedDate not supplied

Dislocation of the incus into the external auditory canal after mountain-biking accident.

We report a rare case of incus dislocation to the external auditory canal after a mountain-biking accident. Otoscopy showed ossicular protrusion in the upper part of the left external auditory canal. CT indicated the disappearance of the incus, and an incus-like bone was found in the left external auditory canal. There was another bony and board-like structure in the attic. During the surgery, a square-shaped bony plate (1 x 1 cm) was found in the attic. It was determined that the bony plate had fallen from the tegmen of the attic. The fracture line in the posterosuperior auditory canal extending to the fossa incudis was identified. According to these findings, it was considered that the incus was pushed into the external auditory canal by the impact of skull injury through the fractured posterosuperior auditory canal, which opened widely enough for incus dislocation.

Adult↗
PubMed1993

[Homograft of incus in tympanoplasty].

Homograft of incus was applied for reconstruction of the ossicular chain in 34 patients. Two basic variations of plastics have been performed. The handle of malleus was supported by the body of the incus with the drilled hole, while the long process of the incus, after a little shortening, was put on the movable footplate of stapes. In the second variation the long process of the incus was amputated--here the drill hole was performed for the head of stapes and the second one in the body of the incus for the handle of malleus. In the average three years after the operation the good hearing results were achieved in 19 (55.9%) patients. From this group in 8 (23.5%) patients aerbone gap closure was at the level of 10 dB. The bad morphologic results was ascertained in 3 patients.

Adolescent↗