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PubMed1987

The surgical management of childhood cholesteatoma.

The results of treatment of 124 cases of childhood cholesteatoma are reported in the present study and compared with an adult group of patients. Intact canal wall tympanoplasty was performed in over 90 per cent of cases in children and the procedure was staged in nearly 80 per cent of cases. The children had a 43.8 per cent incidence of residual cholesteatoma and an 8.8 per cent incidence of recurrent cholesteatoma in intact canal wall tympanoplasty cases. Intact canal wall tympanoplasty remains the technique of choice in our hands for the treatment of childhood cholesteatoma; pre-planned staging of the operation is mandatory for the detection and elimination of residual cholesteatoma which occurs more frequently in children.

Adolescent↗
PubMed1992

Surgery of the 'only hearing ear' with chronic ear disease.

The management of chronic ear disease affecting the only hearing ear is a controversial subject. The relative scarcity of literature on the subject prompted us to prepare a questionnaire which was sent to European and American otologists and to review 19 cases operated at the ENT Clinic of the University of Parma, Italy, and 16 cases operated at The Baptist Memorial Hospital, Memphis, U.S.A. Surgery of cholesteatoma involving the only hearing ear is advised by all the interviewed otologists without exception, even in the presence of a labyrinthine fistula. The cases from the University of Parma were managed as follows: a classic modified radical mastoidectomy was performed in 10 cases, a staged intact canal wall tympanoplasty was done in four cases, an open tympanoplasty in three and a radical mastoidectomy in the remaining two cases. The cases from The Baptist Memorial Hospital were managed with an intact canal wall tympanoplasty (ICWT) in nine and with an open procedure in seven cases. All the otologists interviewed agreed that surgery of the only hearing ear requires particular attention and experience, and should be performed with extreme care by a very experienced surgeon.

Attitude of Health Personnel↗
PubMed1998

Toynbee Memorial Lecture 1997. Middle ear mechanics in normal, diseased and reconstructed ears.

A review of the structure-function relationships in normal, diseased and reconstructed middle ears is presented. Variables used to describe the system are sound pressure, volume velocity and acoustic impedance. We discuss the following: (1) Sound can be transmitted from the ear canal to the cochlea via two mechanisms: the tympanoossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). In the normal ear, middle-ear pressure gain, which is the result of ossicular coupling, is frequency-dependent and smaller than generally believed. Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears. (2) The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapes-cochlear input impedance are compromised. Such analyses are used to explain the air-bone gaps associated with lesions such as ossicular interruption, ossicular fixation and tympanic membrane perforation. (3) With type IV and V tympanoplasty, hearing is determined solely by acoustic coupling. A quantitative analysis of structure-function relationships can both explain the wide range of observed post-operative hearing results and suggest surgical guidelines in order to optimize the post-operative results. (4) In tympanoplasty types I, II and III, the hearing result depends on the efficacy of the reconstructed tympanic membrane, the efficacy of the reconstructed ossicular chain and adequacy of middle-ear aeration. Currently, our knowledge of the mechanics of these three factors is incomplete. The mechanics of mastoidectomy and stapedectomy are also discussed.

Biomechanical Phenomena↗
PubMed2006

Tympanosclerosis involving the ossicular chain: mobility of the stapes in association with hearing results.

CONCLUSION: The preoperative bone conduction level provides not only prognostic information but also information on the mobility of the stapes in tympanosclerosis. The surgical results depend upon the stapes mobility. OBJECTIVES: We aimed to evaluate operative findings and hearing results of tympanosclerosis involving the ossicular chain, in order to understand the pathophysiology and to establish better surgical treatment of tympanosclerosis. PATIENTS AND METHODS: Between January 1998 and March 2004, 29 patients (29 ears) with tympanosclerosis involving the ossicular chain underwent tympanoplasty at our hospital. Patients with myringosclerosis only, or with an associated cholesteatoma, were excluded from this study. The clinical and operational records and pre- and postoperative pure tone audiograms were reviewed retrospectively. RESULTS: Intact canal wall tympanoplasty was applied to all 29 patients. A non-staged operation was performed on 21 patients, and a staged operation was performed on the remaining 8 patients. In 25 patients (86.2%), the sclerotic lesion of the ossicles was located in the epitympanum. In the remaining four, the sclerotic lamella coated only the ossicular chain. On average, the preoperative air conduction hearing level of 57.9 dB was significantly improved to 46.3 dB after tympanoplasty. The success rate of middle ear surgery was 65.5% (19 of 29 patients), according to the criteria of the Otological Society of Japan. In 16 patients (55.2%), the mobility of the stapes was preserved (group A), while in the remaining 13 patients (44.8%), the stapes was fixed (group B). The mean preoperative bone conduction of 25.5 dB in group A was significantly better than that of 37.2 dB in group B. The hearing result significantly improved in group A but not in group B. The success rates were 75% (12 of 16 patients) in group A and 53.8% (7 of 13 patients) in group B.

Adolescent↗
PubMed1998

Use of antibiotic prophylaxis in ear surgery.

A prospective, double-blind, randomized, placebo-controlled study was performed to evaluate the effect of antibiotic prophylaxis in ear surgery. The present study reports on the results of 750 patients, half of whom received cefuroxime for 1 day, the other half, placebo. All postoperative infections occurring within 2 weeks after the intervention were recorded, together with several preoperative and perioperative parameters. It is concluded that exploratory tympanoplasties (including stapedotomy) and "dry perforation" tympanoplasties should be considered "clean" operations according to the American National Research Council and do not benefit from antibiotic prophylaxis. On the other hand, tympanoplasties performed on draining ears and on ears with cholesteatoma should be considered "dirty" operations for which antibiotic prophylaxis may decrease the postoperative infection rate by factor 3. All postoperative infections healed without sequels under proper treatment, except for three that resulted in graft necrosis--one in the placebo group and two in the cefuroxime group. In consequence, prophylaxis may not be mandatory in the dirty group, although the authors advocate its use for the sake of patient and surgeon comfort.

Antibiotic Prophylaxis↗
PubMed2005

Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery.

OBJECTIVES/HYPOTHESIS: Brain herniation and cerebrospinal fluid (CSF) leakage into the middle ear and mastoid are rare but described complications of chronic ear disease. This paper will discuss the presentation and management of brain herniation and/or CSF leak encountered in revision chronic ear surgery. STUDY DESIGN: Retrospective chart review. METHODS: Twelve of 1,130 cases of revision chronic ear surgery in which brain herniation or CSF leak was diagnosed were identified and analyzed. RESULTS: Ten (83%) patients' initial diagnosis was tympanic membrane (TM) perforation with cholesteatoma and two (17%) with TM perforation without cholesteatoma. Initial revision procedures included one (8.3%) tympanoplasty with canal-wall-up mastoidectomy maintaining ossicular continuity, two (17%) tympanoplasties with canal-wall-down (CWD) mastoidectomies with ossicular chain reconstruction (OCR), and nine (75%) tympanoplasties with CWD mastoidectomies without OCR. Three (25%) required a second procedure, two (17%) a third, and one (8.3%) a fourth, finally resulting in four (33%) with an ossicular reconstruction and eight (67%) without. Brain herniation and/or CSF leak were repaired by way of transmastoid and middle fossa approaches. Preoperative and postoperative pure-tone average air-bone gaps were statistically similar (33.1 and 28.1 dbHL, respectively; P = .464). CONCLUSIONS: Brain herniation and/or CSF leak appear to be rare complications of surgery for revision chronic ear disease. Their management require adherence to the principles of establishing a safe ear with hearing restoration as a secondary goal.

Adult↗
PubMed1992

Single-stage management of cholesteatoma.

Surgical management of chronic otitis media with cholesteatoma can be performed in a single-stage procedure, with revision surgery necessary because of recurrent disease or electively with unsatisfactory hearing results. We retrospectively reviewed 164 cases with cholesteatoma surgically managed from 1980 through 1986. In total there were 11 tympanoplasties, 36 canal wall-up mastoidectomies, 81 canal wall down modified radical mastoidectomies, and 36 radical mastoidectomies. The recidivistic rate for cholesteatoma in patients available for 5-year followup was 11% for tympanoplasties, 19% for canal wall-up mastoidectomies, 5% for canal wall-down modified radical mastoidectomies, and 0% for radical mastoidectomies. Hearing results were best in patients who required tympanoplasty alone, followed by those who underwent canal wall-down procedures. Single-stage management of cholesteatoma with modified radical mastoidectomy (canal wall-down) required fewer revisions for recidivistic cholesteatoma and achieved better hearing results than canal wall-up procedures. We conclude, therefore, that staging is not necessary. Improved hearing may likely be achieved with a second procedure, but this is at the patient's discretion.

Adolescent↗
PubMed2002

Revision surgery for chronic otitis media: recurrent-residual disease and hearing.

The aim of this study was to determine the effect of surgical approach, intact canal wall (ICW) or canal wall down (CWD), upon the success of revision surgery for chronic otitis media (COM). A retrospective analysis of 367 patients (including 65 children aged <15 years) who underwent revision tympanoplasty because of persistent disease was performed. Single-staged tympanoplasty was performed, preserving the canal wall when present. Hearing was reconstructed with allograft incus. Follow-up ranged from one to 15 years. Hearing was determined by pre- and post-operative air-bone gaps. Post-operative re-perforation, aural discharge and/or cholesteatoma rates were similar for CWD and ICW. Cholesteatoma could present following the revision, even though it was not apparent at surgery. Following tympanoplasty, the final hearing was not significantly affected by the surgical approach or presence of cholesteatoma. Improvement in hearing was adversely affected by cholesteatoma or an absent stapes suprastructure. Revision ICW and CWD operations were both successful in controlling signs of COM. Cholesteatoma is a peripheral risk in COM and may become apparent after revision surgery.

Adult↗
PubMed2005

Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results.

The combined Heermann and Tos (CHAT) technique is the combination of Heermann's 'cartilage palisade tympanoplasty' and Tos's 'modified combined approach tympanoplasty = modified intact canal wall mastoidectomy'. The first author (Cem Uzun) performed the CHAT technique as a one-stage operation in 15 ears of 15 patients with cholesteatoma. Two patients (one with a follow up of less than six months and one who did not show up at the final re-evaluation) were excluded from the study. Median age in the remaining 13 patients was 37 years (range: 14-57 years). Cholesteatoma type was attic, sinus (Tos tensa type 1) and tensa retraction (Tos tensa type 2) in six, five and two ears, respectively. Cholesteatoma stage was Saleh and Mills stage 1, 2, 3, 4 and 5 in one, three, four, four and one ear, respectively. The eustachian tube was not involved with cholesteatoma in any ear. After drilling of the superoposterior bony annulus, transcanal atticotomy with preservation of thin bridge and cortical mastoidectomy with intact canal wall, the cholesteatoma was removed, and the eardrum and atticotomy were reconstructed with palisades of auricular cartilage. Type I tympanoplasty was performed in two ears, type II in nine ears and type III (stapes absent) in two ears, with either autologous incus (eight cases), cortical bone (two) or auricular cartilage (one). No complication occurred before, during or after surgery. Oto-microscopy and audiometry were done before and at a median of 13 months after surgery (mean 14 months, range 7-30 months). There was no sign of residual or recurrent cholesteatoma in any patient during the follow-up period. At the final examination, all ears were dry and had an intact eardrum except one with a small, central hole, which had been seen since the early post-operative period. Clean and stable attic retraction with a wide access was observed in two ears. Post-operative hearing at the final evaluation was better (change > 10 dB) than the pre-operative one in nine ears and did not change in the remaining four. Pre- and post-operative mean hearing values were, pure-tone average 47 and 35 dB (p = 0.01) and air-bone gap 30 and 20 dB (p = 0.02), respectively. With the CHAT technique, cholesteatoma can be completely and safely removed from the middle ear, and a durable and resistant reconstruction of the middle ear with reasonable hearing can be achieved. However, a further study should analyse long-term results of a larger patient group.

Adolescent↗
PubMed1986

A comparison of PORP, TORP, and incus homograft for ossicular reconstruction in chronic ear surgery.

This report presents the results of 210 cases over a 10-year period using PORPs, TORPs, and notched incus homografts (NIH), for ossicular reconstruction in chronic ear surgery. There were 192 adults and 18 children. The surgical technique utilized temporalis fascia in an underlay technique with canal skin covering the outer surface of the fascia. Intact canal wall mastoid-tympanoplasty, as a one-stage procedure, was used for most cases. Homograft nasal cartilage was placed between the Plasti-Pore prosthesis and the graft. Notched incus homografts were prepared prior to surgery and stored in 4% formalin. There were 149 mastoid-tympanoplasties and 61 tympanoplasties performed. Revision of our cases was performed in 16.6%. Within 3 months of surgery, 86% of adults, and 44% (8/18) of children had dry, healed ears free of disease. The graft take rate was 96%. In adults, a total of 99 NIH, 50 TORPs, and 43 PORPs were implanted. In adults, the closure of the air-bone gap to 20 dB or less occurred in 58% using TORPs, 67% using PORPs, 76% using NIH-Partial replacement, and 20% using NIH-Total replacement. Excluding the cases that failed for reasons other than conductive hearing loss, the results improved to 69% for TORPs, 77% for PORPs, 77% for NIH-P, and 27% for NIH-T. In adults, the extrusion rate was 5.5% for Plasti-Pore and 3% for NIH. In children, the extrusion rate was 17% for Plasti-Pore prostheses. From this study, it appears that PORPs and TORPs with homograft nasal cartilage are satisfactory prostheses for chronic ear surgery in adults. In children, Plasti-Pore prostheses should be avoided unless the ear is healed, aerated, and stable. NIHs are good prostheses when the stapes is intact, but they are inferior to the TORP when placed on the footplate. Also, the NIH requires preparation prior to surgery and may be difficult to obtain. We plan to continue using PORPs and TORPs in chronic ear surgery until a better technique is found, or the complication rate becomes unacceptable.

Adult↗
PubMed2004

[Surgery of cholesteatoma: surgical technique and cholesteatoma recurrences].

Past experience with open and closed techniques of tympanoplasty in surgery of cholesteatoma has shown that recurring illness is one of the major causes of surgical failure. The literature has reported varying trend of surgical treatment of cholesteatoma. The objective of the study was to analyze the significance of surgical technique in relation to the incidence and most frequent localization of recurrent cholesteatoma. Our study analyzed 120 patients operated on for cholesteatoma. The patients were divided into two groups, group I (45) with recurring disease and group II (75) without any recurring condition, which were followed up three years. Statistical analysis was carried out by modified t-test. The largest number of patients was re-operated in the first two years from the initial surgery (50%), In the majority of patients (50%), recurrent cholesteatoma was most commonly localized (stage I) in attic (20%) and much rarely in mesotympanum (11.9%). Stage III recurrent cholesteatoma was verified in 35% of patients, most frequently diffuse form (13.4%). The involvement of attic by all three stages of disease accounted for over 60%. The analysis of the used techniques of surgical treatment in both groups revealed significant difference. Open techniques of tympanoplasty were used in 60% of patients with no recurrence. Closed techniques were used more frequently in patients with recurring disease, i.e. in over 90% of cases. Recurerrent cholesteatoma develops, in the majority of cases, during the first two years after the surgical intervention. Attic is the most common localization of cholesteatoma. More frequent utilization of open technique of tympanoplasty for surgery of cholesteatoma significantly reduces the incidence of recurring condition. The indications for CWD technique are the initial spread of cholesteatoma, possibility of complete removal of cholesteatoma and postoperative follow-up of patients.

Cholesteatoma, Middle Ear↗
PubMed1982

Relationship between the shape of the reconstructed tympanic cavity and the postoperative auditory function.

The dependence of the postoperative hearing function on the shape of the reconstructed tympanic cavity has been evaluated. After reconstructing a large tympanic cavity, the results were very good; after reconstructing a flat tympanic cavity they were good and after reconstructing a cavum minor they were bad. The main cause of bad long-term hearing ability after type IV tympanoplasty was tympanofibrosis. The global results were better following close tympanoplasty than following open tympanoplasty.

Adolescent↗
PubMed2001

[Predictive factors of outcome in 220 ossiculoplasties in adults].

OBJECTIVE: To define factors predictive of outcome after ossiculoplasty in adults. MATERIAL AND METHODS: From 1992 to 1998, 220 ossiculoplasties were performed for chronic otitis media in 200 patients (100 men and 90 women), average age 53 years, age range 17 - 82 years. Ninety-four patients (47%) had not undergone prior surgery (99 ossiculoplasties) and 106 (53%) underwent revision procedures (121 ossiculoplasties). Average follow-up was 20 months. All patients were reexamined at consultations 3 and 12 months after surgery and 100 patients (50%) were reexamined at two years. The operations were classified in type II tympanoplasty when the patient presented a normal stapes (n=120), and a type III tympanoplasty when the stapes arch was absent (n=100). Perforations (n=200) were repaired by temporal aponeurosis in 160 cases (80%) and a tragal perichondrium in 40 cases (20%). The materials used included 23 incus autografts (10%), 105 hydroxyapatite composite Goldenberg prosthesis (48%), 55 all-hydroxyapatite Xomed prosthesis (25%) including 20 covered with a thinned tragal cartilage, 19 teflon Klein prosthesis (9%), 12 Ionos prosthesis (5%) and 6 Malleus prosthesis (3%). The results were analyzed from the microscopic aspect and audiometric data for frequencies 0,5 to 3 KHz. RESULTS: Twenty prosthesis luxed or extruded (9%) within an average of 6 months, 15 (12.4%) after a revision procedure and 5 (5%, p<0,05) after an initial procedure. Fifteen perforations (15/200, 7.5%) occurred, 9 with temporal aponeurosis grafts (9/160, 5.6%) and 6 with perichondrium grafts (6/40, 15%, NS). The residual air-bone gap (ABG) was equal to 23 +/- 12,5 dB with 57% of ABG<20 dB at 12 months follow-up. The gain in air conduction was 14 +/- 16,5 dB and the change in air-bone gap 13 +/- 12,3 dB. Some factors could significantly improve functional results: presence of the stapes arch (n=120, p<0,05), first-intention procedure (n=99, p<0,05), and use of all-hydroxyapatite prosthesis in type II (p<0,05) or type III tympanoplasties. CONCLUSION: Ossiculoplasty with all-hydroxyapatite prosthesis produced satisfactory results in type II or III tympaonoplasties.

Adolescent↗
PubMed1988

[Is measuring impedance following ear operations an aid in the analysis of postoperative sequelae?].

While the diagnostic value of pre-operative tympanometry is undisputed, there are very few publications on its application in postoperative control of sound conduction development. We measured otoadmittance several times after middle ear surgery in 42 cases. A significant increase of maximal admittance is found over a period of up to 24 months in case of tympanoplasty type I (16 cases, Fig. 1), and after stapedectomy (8 cases, Fig. 3). After a tympanoplasty of type III (Wullsteins classification) many tympanograms were flat, even in the follow-up examination, but a tendency to improvement can also be observed (Fig. 2). In none of the groups was hearing loss correlated with otoadmittance. Thus, tympanometry is not suitable for postoperative evaluation of conductive hearing loss. Nevertheless, our results indicate that the healing process after tympanoplasty modifies middle ear sound transmission for quite a long time.

Acoustic Impedance Tests↗
PubMed1988

[Plasma concentrations of lidocaine and prilocaine following infiltration anesthesia in otorhinolaryngologic surgery].

UNLABELLED: Infiltration anaesthesia is still relevant for the surgical treatment of patients in otorhinolaryngology. The injection of local anaesthetics in well vascularised areas constantly causes the danger of high plasma concentrations of local anaesthetics combined with undesirable side effects. In our study we tried to determine the development of plasma concentrations of local anaesthetics in patients scheduled for routine tonsillectomies and tympanoplasty. MATERIALS AND METHODS: In 45 patients the development of plasma concentrations was measured immediately after the injection at short intervals; the samples were obtained between 1 minute and 60 minutes after the first injection. Group 1: Lidocaine 0.5% with epinephrine (1:200,000) 15-20 ml for tonsillectomy (n = 18). Group 2: Lidocaine 0.5% with epinephrine (1:200,000) 8-15 ml for tympanoplasty (n = 15). Group 3: Prilocaine 1% with epinephrine (1:200,000) 8-15 ml for tympanoplasty (n = 15). For tactical reasons infiltration anaesthesia for the patients of group 2 was - in addition to general anaesthesia - applied by the otorhinolaryngologist, whereas the patients of groups 1 and 3 were operated exclusively under local anaesthesia. RESULTS: Within the first minute after the initial injection plasma concentrations of the local anesthetic increased close to toxic threshold levels that are associated with undesirable systemic side effects. In the patients of group 1, who underwent tonsillectomy, plasma concentrations of 4-7 micrograms/ml were found during the first minute. The highest average values always appeared within the first five minutes: group 1 2.07 micrograms/ml, group 2: 0.45 micrograms/ml, and group 3: 1.15 micrograms/ml. DISCUSSION: With infiltration anaesthesia in well vascularised areas it may happen that there are--mainly in the early stage--high plasma concentrations of the applied substances, although the total dose was below the known maximum. Despite careful technique (repeated aspiration test in two levels) at least partial intravascular injections are apparently not always avoidable according to the pharmacokinetic data. Our results demonstrate that in addition to a safe peripheral venous line and prophylactic oxygen therapy, intraoperative monitoring of blood pressure, heart rate, electrocardiogram and verbal patient monitoring is of advantage in this group of patients. In our opinion the "standby function" of an anaesthesiologist can avoid severe complications.

Adolescent↗
PubMed1982

Assessment of postoperative hearing in 528 middle ear and mastoid surgery cases in Tokai University Hospital.

The postoperative hearing results in cases of tympanoplasty, radical mastoidectomy, modified radical mastoidectomy and tympanoplasty combined with modified radical mastoidectomy on 528 ears, performed in the Tokai University Hospital between 1975 and 1980 were assessed. The assessment was based on pure-tone audiograms taken 3 months to 5 years after the operation. Out of 528 cases 70.5% gained better postoperative hearing, 6% showed no change of hearing and 23.5% showed deterioration of hearing. Auditory success of those who attained social hearing, air-bone gap closure to within 20dB or gained hearing of 20 dB or more was 53.4%. The results in cholesteatoma cases were poorer than those of non-cholesteatoma cases. In 44% of the cases, ossiculoplasty was performed, and the most successful ossiculoplasty results were obtained when the malleus was repositioned to the head of the stapes. Fairly good results were achieved when an artificial prosthesis, such as a Teflon-piston, Gelfoam-wire or platinum-piston, was used. The least successful results were found when the incus was transpositioned. In the non-ossiculoplasty group, type I tympanoplasty produced 59.5% auditory success whereas 37.3% auditory success was achieved in radical mastoidectomy. Better auditory success rates were obtained when the bony bridge was preserved than when it was removed. The results were identical in cases where the mastoid cavity was obliterated or when it was kept open. A new technique, "scutumplasty", was used for reconstructing the scutum. Revision surgery was required in only 3.4% of the cases.

Hearing↗
PubMed1994

[Evaluation of bone conduction after chronic ear surgery and after stapedectomy].

The bone conduction threshold changes of 295 ears which underwent chronic ear surgery (177 ears) or stapedectomy (118 ears) were determined by comparing last preoperative with 4 to 6 weeks postoperative audiogram. Three types of middle ear operations were evaluated: radical mastoidectomy, modified radical mastoidectomy and intact wall mastoidectomy with tympanoplasty (first stage). A total stapedectomy was performed with adipose seal and tarflen prosthesis. The preoperative mean bone conduction thresholds of radical mastoidectomy at 2000-4000 Hz frequency range was significantly worse when compared to radical modified mastoidectomy and to mastoidectomy with tympanoplasty (first stage). A significant deterioration of mean bone conduction thresholds at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz was observed after open techniques and at 2000 Hz and 4000 Hz after intact wall mastoidectomy with tympanoplasty (first stage). After stapedectomy a positive change (improvement of mean bone conduction) was noted at 1000 Hz and 2000 Hz. It seems that observed changes in the bone conduction thresholds may be due to damaging risk of surgical procedure (chronic ear surgery and stapedectomy) and influence of ossicular chain mobilisation on bone conduction transmission (stapedectomy).

Acoustic Stimulation↗
PubMed1998

Gold prostheses for ossiculoplasty.

OBJECTIVE: To review the results of ossicular chain reconstruction with partial and total ossicular replacement prostheses made of gold. STUDY DESIGN: Retrospective case review. SETTING: A tertiary referral center. PATIENTS: Fifty-nine patients underwent surgery between November 1993 and February 1996 and underwent follow-up for at least 12 months. Tympanoplasty was performed because of cholesteatoma, chronic otitis media, adhesive otitis media, and trauma. INTERVENTION: Tympanoplasty and ossiculoplasty with partial or total replacement gold prostheses. MAIN OUTCOME MEASURE: The clinical and hearing results of ossiculoplasty. RESULTS: In 62% of the patients in whom partial ossicular replacement prostheses were used, the residual air-bone gap could be reduced to < or =20 dB. In cases with total ossicular replacement prostheses, the air-bone gap could be closed to < or =20 dB in 42%. Extrusion of the prosthesis occurred in 11 cases (19%) between 7 and 21 months after tympanoplasty. In most extrusion cases (55%), this was combined with a significant retraction of the tympanic membrane. Primary and staged procedures showed different extrusion rates. CONCLUSIONS: Hearing results in the current study are comparable to results described by other authors for synthetic middle ear prostheses. Implant rejection was never encountered, with the gold implants exhibiting a high biocompatibility. Nevertheless, prosthesis extrusion occurred rather often in the course of tympanic membrane retraction. Staging the surgery or different shaping of the prosthesis may be helpful to prevent prosthesis extrusion.

Adolescent↗