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At least 19 recordsLinked to original sources
PubMed2000

Hearing results in pediatric patients with chronic otitis media after ossicular reconstruction with partial ossicular replacement prostheses and total ossicular replacement prostheses.

OBJECTIVE: To examine hearing results in pediatric patients after ossicular reconstruction with partial ossicular replacement prostheses (PORPs) and total ossicular replacement prostheses (TORPs) in children with chronic otitis media. METHODS: A retrospective chart review was performed on 55 pediatric patients with chronic otitis media who underwent ossicular reconstruction from 1991 to 1998. Patients' audiograms were evaluated preoperatively and postoperatively for pure-tone average (PTA), air-bone gap (ABG), speech reception threshold (SRT), method of ossicular reconstruction, and management of the mastoid. RESULTS: Twenty-seven patients underwent ossicular reconstruction with TORPs. The average preoperative ABG was 40.1 dB, and the average postoperative ABG was 31.6 dB. Forty-one percent of the children improved their PTA greater than 10 dB postoperatively, and 52% of children did not change their ABG by more than 10 dB postoperatively. Nineteen percent of children with TORPs had a postoperative ABG less than 20 dB, and 44% of children with TORPs had a postoperative ABG less than 30 dB. Twenty-eight patients underwent ossicular reconstruction with PORPs. The average preoperative ABG was 29.7 dB, and the average postoperative ABG was 22.5 dB. Thirty-two percent of patients improved their PTA by greater than 10 dB, while 57% of children with PORPs did not change their ABG by more than 10 dB postoperatively. Forty-three percent of children with PORPs had an ABG of less than 20 dB postoperatively, and 71% of children with PORPs had a postoperative ABG less than or equal to 30 dB. CONCLUSIONS: Children who underwent ossicular reconstruction with PORPs had slightly better postoperative hearing than did children with TORPs. Postoperative hearing was essentially unchanged in approximately 55% of both groups. Preoperative hearing levels may be the most important factor determining postoperative hearing in nonstaged surgery for children with chronic otitis media Long-term hearing results in children with single-stage surgery were not as good as those reported in the literature for staged surgery. Severe mucosal disease and eustachian tube dysfunction may contribute to poorer hearing results in children.

Audiometry, Pure-Tone↗
PubMedDate not supplied

Five-year report on partial ossicular replacement prostheses and total ossicular replacement prostheses.

Although much progress has been achieved in the functional restoration of ears damaged by chronic suppurative otitis media since the introduction of tympanoplasty 30 years ago, adequate hearing improvements in ears with loss of the stapedial arch have been the most elusive. It is now recognized that such ears present the surgeon with numerous associated problems that require control for a satisfactory outcome; the problem of establishing an efficient link between the tympanic membrane and oval window has proved the most difficult. The introduction of biocompatible materials was heralded as a possible solution. In order to evaluate the claims for these new materials, the five-year results obtained with one of these, porous polyethylene, were evaluated. The one-year success rate with partial ossicular replacement prostheses was 64%; the five-year success rate was 43%. With total ossicular replacement prostheses the success rate was 59% at one year and 22% at five years. These poor results, coupled with evidence of digestion of porous polyethylene, give little justification for the continued use of this material in tympanoplasty.

Ear Ossicles↗
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↗
PubMed1995

Ossiculoplasty using the black hydroxylapatite hybrid ossicular replacement prostheses.

The problems of ossicular reconstruction in chronic ear surgery have led to the development of new ossicular replacement prostheses. Improvements in biocompatibility and design led to the development of hydroxylapatite hybrid (HaH) ossicular replacement prostheses. The senior author's (M.E.G.) experience with the Black HaH prostheses is reviewed. Sixty cases are grouped by procedure and prosthesis (19 TORPs and 41 PORPs) with a minimum follow-up of 1 year. Audiometric data are analyzed to determine the success rate in air-bone gap closure. Complication and extrusion rates are reviewed. These results are compared against those obtained using other prostheses using similar criteria, and this report serves as a follow-up on a previous paper on this subject by the senior author.

Adult↗
PubMed1990

Design and development of a contoured ossicular replacement prosthesis: clinical trials of 125 cases.

A columellar ossicular replacement prosthesis has been developed to simplify ossiculoplasties. The hydroxylapatite head has flattened egg-shaped contours set on a teflon shaft. One hundred and twenty-five prostheses have been implanted and the results of eighty-two cases between five and eighteen months' maturity are presented. Sixty-six percent of good risk partial ossicular replacement prosthesis (PORP) cases achieved air-bone closure within ten decibels and eighty-five percent within twenty decibels. Of all total ossicular replacement prosthesis (TORP) and PORP cases, 51.5 percent closed to within ten decibels and 69.5 percent to within twenty decibels. The design has simplified the preparation and implantation techniques and the prosthesis can be used in most ossiculoplasty situations. A malleus handle is not required and interposition of cartilage is unnecessary. The simplicity of the prosthesis should provide particular benefits for the occasional or trainee otologist.

Clinical Trials as Topic↗
PubMed1987

Synthetic ossicular replacements: normal and abnormal CT appearance.

Twenty-two patients with synthetic ossicular replacements were studied with computed tomography (CT). Twelve patients had total ossicular replacement prostheses (TORPs), and ten patients had partial ossicular replacement prostheses (PORPs). Good results were achieved in 12 patients (eight with TORPs and four with PORPs). Four of these prostheses were clearly visible on CT scans, six were discernible, and two were not identified. In the ten patients with unsatisfactory surgical results, CT was performed before surgical revision. It disclosed subluxation of the prosthesis in four patients and fibrous tissue fixation in four. In two patients the CT scan appeared normal; surgery disclosed lateralization of the graft with a nonfunctioning interface.

Ear Ossicles↗
PubMed1990

Hydroxylapatite ossicular replacement prostheses: preliminary results.

Hearing results and extrusion rate for 89 consecutive patients receiving hydroxylapatite prostheses for hearing reconstruction were evaluated and compared to a control group of 75 patients who had received homograft bone or Plasti-Pore prostheses. At the 3-month follow-up, there were no cases of extrusion of the hydroxylapatite prostheses. Hearing success was defined as a postoperative air-bone gap of less than or equal to 15 dB for incus prostheses and partial ossicular replacement prostheses or less than or equal to 25 dB for incus-stapes prostheses and total ossicular replacement prostheses. There was a statistically significant difference in the distribution-of-success rate by prosthesis type for the hydroxylapatite. Incus, incus-stapes, and total ossicular replacement prosthesis results were similar, but partial ossicular replacement prosthesis results were poorer. The overall success rate in the hydroxylapatite group was 51.2%; in the control group, it was 60%. Hearing results tended to be better with the hydroxylapatite incus prosthesis than with the homograft bone incus, but poorer with the hydroxylapatite partial ossicular replacement prosthesis than with the Plasti-Pore. Several technical modifications of the prosthesis that may improve results with the hydroxylapatite partial ossicular replacement prosthesis are suggested. Hydroxylapatite middle ear prostheses appear to be a reasonable alternative to other more commonly used prostheses, which carry disadvantages related to the use of human tissue.

Adolescent↗
PubMed1982

Ossicular replacement with self-stabilizing presculptured homologous cartilage.

The use of self-stabilizing, alloplastic ossicular replacement prostheses introduced by Shea and Homsy has improved postsurgical hearing results in patients with major ossicular defects. While hearing results after total and partial ossicular replacement are good, many authors have reported high rates of extrusion of these alloplastic materials. A technique is herein described in which an all-cartilage homograft is presculptured into a self-stabilizing configuration. Twenty-three such total and partial ossicular replacement grafts were performed with a follow-up of at least 25 months; none of the cartilage struts has extruded. The self-stabilizing, presculptured homologous cartilage graft provides an alternative for surgeons who wish to avoid alloplastic materials in ossicular reconstruction.

Cartilage↗
PubMed1994

Total and partial ossicular replacement prostheses in children.

Although ossicular reconstruction in children may carry a risk of failure because of recurrent middle ear disease, the procedure offers the potential for restoring binaural hearing during the school years when it is so critical. Of a series of 45 reconstructions with total and partial ossicular replacement prostheses, 6 were extruded for a surgical success rate of 87%. Of the successful cases, 74% had air-bone gaps of 30 dB or better, and 74% had speech reception thresholds of 30 dB or better on initial postoperative audiogram. Outcomes for these children were comparable with those reported for adults, supporting the value of early reconstruction.

Child↗
PubMed1979

Experience with a polyethylene total ossicular replacement prosthesis.

Surgical reconstruction of ossicular defects in chronic middle ear disease is a difficult problem. We have reviewed our results with the use of the Plastipore total ossicular replacement prosthesis (TORP). Of 29 procedures that were analyzed, nine were considered successful. None of our patients had a stapes superstructure, and 13 had no malleus. Placement of the TORP under the malleus handle and use of extra tissue between the prosthesis and the tympanic membrane provided better hearing results, but extrusion of the prothesis still occurred. Positioning of the prosthesis and contraction of the middle ear space, which causes extrusion of the prosthesis, remain problems in this type of reconstruction.

Adolescent↗
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↗
PubMed1994

Implantation of electromagnetic ossicular replacement device.

Semi-implantable hearing aids consisting of permanent middle ear implanted magnet, either partial ossicular replacement prostheses (PORP's) or total ossicular replacement prostheses (TORP's) driven by an electromagnet placed in the ear canal have been tested on six patients undergoing surgery for chronic otitis. The surgical and audiological problems are described. The audiological results were excellent in all six cases. A functional gain of 40-70 dB can be obtained for entire frequency range of the audiogram.

Aged↗
PubMed1986

Ossiculoplasty failure with ceramic ossicular replacement prosthesis.

The stability of ceramic ossicular replacement prosthesis (CORP) in the middle ear was evaluated in 162 ears that had been followed for more than 18 months. The CORP extruded from 8 ears (4.9%) and was dislocated in 6 ears (3.7%). These failures were considered to be due mainly to postoperative tubal dysfunction and disease recurrence. CORP should not be used when such conditions can be anticipated.

Adolescent↗
PubMedDate not supplied

Titanium and glass-ionomer cement as ossicular replacement materials: biocompatibility results after implantation in the rabbit.

The middle ear poses unique challenges when finding suitable materials for ossicular reconstruction, primarily because of its link to the external environment via the eustachian tube, which leads to a greater potential for exposure to infectious agents. In this animal study, the biocompatibilities of titanium and glass-ionomer cement were assessed in the middle ear of the rabbit after being implanted as total ossicular replacement prostheses (TORPs) or as free pins. Animals were sacrificed after 28, 84, 168, 336, or 504 days or 2 years, and a cutting saw technique was used to prepare slides for light microscopy. Slides were examined for mucosal coverage and any sign of foreign body reaction. Both materials showed good acceptance in the middle ear. After 28 days, the TORPs were covered by middle ear mucosa. As expected, it took a longer time (up to 504 days) to cover the free implants. An interesting finding was the growth of new bone on both the surface of the titanium implants and the glass-ionomer prostheses. The results of this animal study indicate that both titanium and glass-ionomer cement are favorable materials for ossicular replacement prostheses.

Animals↗
PubMedDate not supplied

Aluminum oxide ceramic ossicular replacement prosthesis.

Two different prototypes of columella materials made from aluminum oxide ceramics were newly designed by the author for ossicular reconstruction. CORP-P (ceramic ossicular replacement prosthesis-partial) is used as a columella to fit onto the stapes head, and CORP-T (ceramic ossicular replacement prosthesis-total) is used as a columella placed onto the footplate of the stapes. In addition to the general properties of ceramic implants, CORP has these two characteristics: the unique shape of its head, which allows easy and smooth contact with the fascia graft, and the radiopacity, which makes it possible to confirm the position of the implants by x-ray examination after implantation.

Aluminum Oxide↗
PubMed1991

A universal ossicular replacement prosthesis: clinical trials of 152 cases.

An ossicular replacement prosthesis is described that advances implant design in several respects. The head is a flattened egg shape, which eliminates pressure points against the pars tensa and provided balance on the stapes. Dense hydroxylapatite ceramic provides maximal biocompatibility. The shaft, of either Teflon or Plastipore, is easily cut to size and is replaceable to minimize wastage. Interchangeable partial or total shaft variants are provided. Trials in more than 200 patients have produced optimal results. Among 152 mature patients in 85% of the good-risk cases, the air-bone gap closed to within 20 dB and in 65% to within 10 dB; in 69% of all cases the gap closed to within 20 dB. Extrusion rates were 5% in good-risk cases and 7% overall. Long-term extrusions have not occurred. Inasmuch as cartilage interpositioning is unnecessary, the prosthesis is rapidly prepared and implanted by an easily mastered technique.

Bone Conduction↗
PubMed1987

Soft tissue reaction to ceramic ossicular replacement prosthesis.

Soft-tissue reaction to ceramic ossicular replacement prostheses (CORP) has been evaluated histologically in rabbits and humans. One week after implantation, severe inflammatory and foreign body reaction was observed in the fibrous connective tissue surrounding the prosthesis. Though some inflammatory response was seen after one month, after three months the CORP was surrounded by a layer of fibrous connective tissue without any foreign body giant cell, histiocyte or inflammatory cell infiltration. Our satisfactory clinical results in humans without placing a cartilage between the CORP and the fascia graft may be due to the excellent soft-tissue compatibility of CORP, as demonstrated in this study.

Aluminum↗
PubMed2000

Middle-ear dynamics before and after ossicular replacement.

The mechanism of hearing involves conduction of mechanical vibrations along the ossicular chain to the inner ear. An acoustic wave is collected and transformed as it passes down the ear canal and impacts on the tympanic membrane (ear drum). The drum is connected to the inner-ear by three ossicle bones (malleus, incus, and stapes) in a complex arrangement, which serves to further transform the mechanical vibration before it reaches the cochlea of the inner ear. What is the mechanical function of the ossicular chain, and what are the biomechanical consequences of surgical reconstruction with prostheses? To answer these questions, a three-dimensional finite element model of the outer ear canal and middle ear was generated. The dynamical behaviour was predicted for the normal ear, and an ear reconstructed with partial and total ossicular replacement prostheses. For the normal ear, stapes amplitudes of 1x10(-8) m at low frequencies decrease to 4x10(-10)m at approximately 3kHz with several resonance peeks in between, most significantly at approximately 1kHz. Thereafter a further resonance is predicted at 4kHz associated with the ear canal. The behaviour is changed fundamentally by adding a prosthesis; the partial replacement increases the vibratory coupling of the drum and the stapes compared to the normal ear whereas the total replacement does the opposite, and is predicted to have the disadvantage of bringing several new resonances of the ossicular chain into the hearing range. It is hypothesised that the function of the malleus-incus-stapes arrangement is to link the drum to the oval window with the flexibility required for impedance matching but the rigidity to prevent unconstrainable resonances from occurring in the hearing range. If this is true, then the structural stiffness of ossicular chain is the critical design variable for middle-ear replacement prostheses.

Acoustics↗