Predictors of hearing outcomes in patients undergoing ossicular chain reconstruction in a developing country / Factores predictores de desenlaces auditivos en pacientes llevados a reconstrucción de la cadena osicular en un país en vía de desarrollo

Objective: To explore the social and clinical factors that predict audiometric outcomes in patients undergoing ossicular chain reconstruction. Methods: A retrospective analytical cohort study was conducted, including patients 18 years of age or older with a history of chronic otitis media (COM) and/or any of its complications, who underwent ossicular chain reconstruction with Partial Ossicular Replacement Prosthesis (PORP) or Total Ossicular Replacement Prosthesis (TORP), at Hospital San José and Hospital infantile Universitario de San José between 2012 and 2020. We excluded patients with ossicular chain malformations and those with incomplete information. Information about sociodemographic and clinical factors was collected. Additionally, the surgery findings information was analyzed using the Ossiculoplasty outcome parameter staging ( OOPS) index. Results: A total of 35 adult patients who underwent ossicular chain reconstruction were retrospectively studied. An improvement was evidenced in the Preoperative Pure-Tone Average (PTA) and postoperative PTA (p-value=0.036), as well as in the pre and postoperative air-bone gap (ABG) (p-value < 0.01). A moderate correlation coefficient was found between the OOPS index and the postoperative PTA (p= 0.429), and between the OOPS index and the postoperative (ABG) (p= 0.653). Conclusion: We found that a higher OOPS score is correlated with worse hearing outcomes postoperatively, and there was no association between the demographic or pathologic factors with a worse postoperative hearing outcome. Therefore, OOPS index can predict audiometric outcomes in patients undergoing ossicular chain reconstruction in a developing country, regardless of the demographic or pathologic factors.

Objetivo: Evaluar los factores sociales y clínicos que predicen los desenlaces audiométricos en pacientes llevados a reconstrucción de cadena osicular en un país envía de desarrollo. Métodos: Se realizo un estudio de cohorte analítico retrospectivo donde se incluyeron pacientes mayores de 18 años, con antecedente de otitis media crónica y/o alguna complicación/secuela de esta, que fueron llevados a reconstrucción de la cadena osicular con prótesis PORP - TORP de la Fundación Universitaria de Ciencias de la Salud entre el año 2012 y 2020, se excluyeron pacientes con malformaciones de la cadena osicular y aquellos con informacion incompleta de su historia clinica y quirurgica. Resultados: La población estudiada fue 35 pacientes, en los cuales se compararon variables demográficas, antecedentes de rinitis o tabaquismo activo, parámetros audiológicos pre y postoperatorios, y hallazgos intraquirurgicos. Se evidenció una diferencia estadísticamente significativa entre el promedio tonal auditivo (PTA) preoperatorio y el PTA postoperatorio (p-valor=0.036), así como en el gap aéreo- oseo pre y post operatorio ( p-valor < 0.01). Se reportó un coeficiente de correlación moderado entre el índice OOPS y el PTA post operatorio (p = 0.429), y entre el índice OOPS y el gap aéreo óseo post operatorio (p = 0.653), lo que indica que a mayor puntaje en el índice OOPS peores desenlaces auditivos. Conclusión: En este estudio un mayor puntaje en el índice OOPS se correlacionó con peores desenlaces auditivos. No se evidenció correlación entre los factores demográficos u otras comorbilidades descritas y un peor desenlace auditivo post operatorio. Aunque se obtuvo un GAO postoperatorio ≤20dB en el 48.5% de los pacientes, se observó una disminución en el GAO estadísticamente significativo.

Discussion of Application Status and Key Attentions on Registration for Ossicular Replacement Prosthesis / 中国医疗器械杂志

The ossicular replacement prosthesis should have good biocompatibility, stability, easy to install, and excellent sound transmission capacity. In this study, the characteristics of ideal materials for the ossicular replacement prosthesis were analyzed by searching the types of materials used in clinical practice and comparing the advantages and disadvantages of various materials and structures. At the same time, in combination with the current evaluation requirements and evaluation experience, the focus of the performance research project of ossicular replacement prosthesis in the process of registration is discussed to clarify the performance evaluation requirements of these products, so as to provide reference for the future work of manufacturers and regulators. The performance evaluation of ossicular replacement prosthesis focuses on its mechanical properties, fixation stability, sound transmission characteristics, biological characteristics, and magnetic resonance compatibility.

Congenital middle ear malformation: clinical analysis and discussion of classification / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the clinical characteristics and appropriate surgical procedures, and discuss the classification of congenital middle ear malformation.@*Methods@#All cases were from the Center of Otorhinolaryngology, the Sixth Medical Center of Department of PLA General Hospital. All of these cases, including 26 male patients (ears) , 10 female patients (11 ears) , aged from 7 to 57 years old, had normal external auditory canal, tympanic membrane, conductive hearing loss, type A tympanogram and negative Gelle′s test. Tympanoplasty was performed in all cases. The deformity was classified to three types,i.e., Type I (stapes foot plate mobility): Ⅰa, ossicular chain deformity with normal stapes suprastructure; Ⅰb, ossicular chain deformity with abnormal stapes suprastructure; Type Ⅱ (stapes foot plate fixation): Ⅱ a,normal ossicular chain, Ⅱ b, ossicular chain malformation; and Type Ⅲ: vestibular window osseous atresia or undeveloped, or with round window atresia. The malformation of type Ⅱ and Ⅲ may be accompanied with abnormal facial nerve. In addition, the papers on middle ear malformation published from 1982 to 2017 were analyzed retrospectively. The clinical data of 451 ears malformation were summarized.@*Results@#According to the revisional classification criteria in 37 ear samples from our hospital, 20 ears were type I. 6 type Ⅰa cases were used PORP (partial ossicular replacement prosthesis) to reconstruct the ossicular chain; 14 type Ⅰb cases were used TORP (total ossicular replacement prosthesis) to reconstruct the ossicular chain. For the 5 ears of type Ⅱ, 2 of which were type Ⅱ a and 3 were type Ⅱ b. 4 ear samples of type Ⅱ were implanted with Piston ossicular prosthesis, 1 was implanted with TORP in which the ossificated foot plate was removed with periosteum preserved. 12 ear samples were type Ⅲ, with vestibular window osseous atresia, facial nerve malformation, and stapes suprastructure malformation. The pistons ossicular prosthesis were implanted in vestibular window in 3 ears with facial nerve covering vestibular window partially. The surgery had to be given up in 5 ears, and TORP was implanted in 4 ears at the opening with preserved periosteum at the beginning of the tympanic scala because of facial nerve covering vestibular window totally. 30 ears with complete follow-up data had no sensorineural hearing loss and the average air-bone conduction decreased 23.3±10.7 dB (P<0.05).There were 234 ears of type Ⅰ in 451 ears of congenital middle ear malformation reported in the literature. 113 of which were type Ⅰa, the basic surgery was ossicular chain shaking and artificial or autogenous PORP implantation. Type Ⅰb was 121 ears, with autogenous or artificial TORP and PORP. Type Ⅱ was125 ears, including type Ⅱa 22 ears, Ⅱb 60 ears, and no subclassification for 43 ears. The surgery of type Ⅱ was the same as otosclerosis. The vestibular window atresia of type Ⅲ was 92 ears, the surgery of 17 ears had to be abandoned, the other ears underwent vestibular window, promontory or semicircular canal opening to reconstruct hearing with Piston, autogenous or artificial TORP.@*Conclusion@#Referring to the classification of congenital middle ear malformation combining with appropriate surgical materials and methods, otologists can better understand and choose appropriate surgical method to the middle ear malformation.

The Efficacy of Endoscopic Exploratory Tympanotomy in Conductive Hearing Loss Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to investigate the effectiveness of the endoscopic exclusive transcanalar approach for the management of conductive hearing loss. SUBJECTS AND METHOD: This was a retrospective comparative study of 106 patients who underwent exploratory tympanotomy at Chonnam National University Hospital from January 2008 to March 2016. The subjects were classified into two groups; endoscopic tympanotomy (ET, n=26) and microscopic tympanotomy (MT, n=80). Demographic data, operation time, postoperative admission days, pure tone audiometric results of pre-operation and post-operation at 3 months, and hearing success rate were evaluated. RESULTS: The mean operation time of MT (101.7±24.8 minutes) was longer than that of ET (59.8±23.2 minutes) with a statistical significance (p<0.01). The mean postoperative admission days of MT (4.4±1.3) was longer than that of ET (2.0±0.6) with a statistical significance (p<0.01). Hearing gain (air-conduction) and air-bone gap improvements were not significantly different between the groups. However, the hearing success rate of ET [partial ossicular replacement prosthesis (PORP) 85.7%, total ossicular replacement prosthesis (TORP) 81.8%] was significantly improved enormously compared to that of MT (PORP 62.9%, TORP 64.3%). CONCLUSION: With regards to conductive hearing loss, the endoscopic approach provided a better surgical view and less invasiveness compared with the microscopic approach. In conclusion, endoscopic exploratory tympanotomy had several advantages in operation time, admission days and hearing success rate.

Effects of bacterial biofilm on hearing restoration with titanium partial ossicular prosthesis replacement / 医用生物力学

Objective To study effects of the bacterial biofilm at different growth stages on dynamic behavior of the titanium partial ossicular replacement prosthesis (PORP), so as to provide theoretical references for clinical treatment of diseases such as secretory otitis media. Methods Based on the CT scan images of normal human right ear and combined with the self compiling program, a 3D finite element model of the ear was reconstructed for dynamic analysis on sound conduction, and compared with the experimental data. The model was computed by harmonic response analysis method, and the sound conduction effect of bacterial biofilm grown on PORP at different growth stages was analyzed. Results The simulated amplitude of umbo and stapes footplate was in accordance with experimental measurements, which confirmed the validity of this numerical model. The existence of biofilm would cause 0-1.6 dB hearing loss at low frequencies. The growth of biofilm in the radial direction of PORP would cause 0-12 dB hearing loss at intermediate and high frequencies, especially at 8 kHz, and the hearing loss could be as high as 11.2 dB. Conclusions The bacterial biofilm has an impact on hearing by reducing the hearing at low frequencies while raising a little at high frequencies. The biofilm grown in the radial direction of PORP will reduce hearing, and affect the working efficiency of PORP on hearing restoration.

Avaliação audiométrica após estapedotomia com prótese de titânio do tipo Fisch / Audiometric evaluation after stapedotomy with Fisch titanium prosthesis

Otosclerose é uma doença que provoca fixação do estribo, levando à perda auditiva tipicamente condutiva, corrigida com aparelhos auditivos ou cirurgia de estapedotomia, substituindo o estribo doente por uma prótese. O material mais recentemente utilizado é o titânio e no Brasil há apenas duas próteses comercialmente disponíveis. A prótese de pistão tipo Fisch, da Storz, não possui resultados relatados na literatura. OBJETIVO: Estudo retrospectivo avaliando resultado auditivo após estapedotomia com uso desta prótese. MÉTODO: Usando critérios da Academia Americana de Otorrinolaringologia, comparou-se o gap nas audiometrias pré e pós-operatórias, avaliando-se melhora auditiva. RESULTADOS: O gap pós-operatório em baixas frequências teve média de 12,9 dB, em altas frequências de 5,2 dB (média 9,1 dB), mediana 8,8 dB, mínimo 1,3 dB e máximo 21,6 dB, desvio padrão 5,7 e p < 0,001. Dividindo o resultado conforme o gap pós-operatório a cada 10 dB, em 25 pacientes (75,8%) foi < ou igual a 10 dB, em 32 pacientes (96,9%) foi < ou igual a 20 dB, em 100% dos casos foi < ou igual a 30 dB. CONCLUSÃO: Prótese de pistão tipo Fisch apresenta resultados compatíveis com a literatura, podendo ser usada com segurança como mais uma boa opção para estapedotomia.

Otosclerosis causes the fixation of the stapes and conductive hearing loss, usually corrected with the use of hearing aids or through stapedotomy and the replacement of the involved stapes with a prosthesis. Titanium has been the most recently used material of choice in stapedotomy prostheses. Only two prostheses are commercially available in Brazil. There are no reports in the literature on the Fisch-type Storz titanium stapes piston prosthesis. OBJECTIVE: This retrospective study aims to look into the auditory outcomes of patients submitted to stapedotomy and titanium stapes piston prosthesis implantation. METHOD: The criteria described by the American Academy of Otolaryngology were used to compare pre and postoperative air-bone gaps seen in audiometry tests. RESULTS: The mean low-frequency postoperative air-bone gap was 12.9 dB; the mean high-frequency air-bone gap was 5.2 dB (mean 9.1 dB); median gap was 8.8 dB, with a minimum of 1.3 dB and a maximum of 21.6 dB; standard deviation was 5.7 dB, and p < 0.001. Twenty-five (75.8%) patients had air-bone gaps of 10 dB and under; 32 (96.9%) patients had gaps of 20 dB and under; and all patients had gaps of 30 dB and under. CONCLUSION: The Fisch-type titanium stapes piston prosthesis presented outcomes consistent with the literature and can be used safely in stapedotomy procedures.

Effect of partial ossicular prosthesis replacement on hearing restoration of human / 医用生物力学

Objective To study the postoperative effects on hearing restoration after different types of ossicular reconstruction with partial ossicular replacement prosthesis (PORP). Methods CT data of the right ear from a healthy volunteer were digitalized and imported into PATRAN software to reconstruct the 3D finite element model of the ear by a self compiling program. Dynamic analysis was conducted on the sound transmission to make comparison between the calculated results and experimental data. Results Results of the dynamic analysis for normal human ear were in good agreement with the experiment data, which confirmed the validity of the FE model. At the frequency between 0.1~10 kHz, hearing restoration with partial retaining the handle of malleus was better than that without retention after the replacement of PORP, and the value of hearing restoration was between 11.56~28.91 dB. The maximum stress of tympanic membrane with partial retaining the handle of malleus was less than that without retaining. At the frequency between 0.1~0.6 kHz as well as between 2~10 kHz, better hearing restoration was obtained when the thickness of the cartilage slice was 2.0 mm. At the frequency between 0.6~2 kHz, better hearing restoration was obtained when the thickness of the cartilage slice was 0.1 mm. Conclusions For ossicular reconstruction with PORP, the effect of retaining the handle of malleus was much better than that without retaining. The effect of hearing restoration was better when the thickness of the cartilage placed between the tympanic membrane and the contact surface of the PORP was within the range of 0.1~2.0 mm.

Effectiveness of Stapes Mobilization in Tympanosclerotic Stapes Fixation

BACKGROUND AND OBJECTIVES: Tympanosclerosis is a nonspecific and irreversible result of chronic inflammation or infection of the middle ear. However, there remains disagreement about how best to surgically treat tympanosclerotic ossicular fixation, with the controversy over its management when stapes is involved. The aim of this study was to evaluate operative findings and hearing results of tympanosclerosis involving the ossicular chain, which in turn would establish better surgical treatment of tympanosclerotic ossicular fixation. SUBJECTS AND METHODS: In this prospective study conducted from Mar 2000 to Dec 2007, 38 patients with tympanosclerosis who had undergone surgical treatment were evaluated. The clinical and operational records and pre- and postoperative pure tone audiograms were reviewed. RESULTS: Operative findings showed stapes fixation is the most common. In 8 patients (21.1%), stapes was mobile, while, in the remaining 30 patients (78.9%), stapes fixation was found. In all cases with stapes fixation, stapes mobilization was possible. Following hearing result reporting guideline by the Korean Otological Society, the success rate of middle ear surgery was 68.4% (26 of 38 patients). In cases with stapes fixation, the success rate was 66.6% (20 of 30 patients), while, in cases with no stapes fixation, the success rate was 75.0% (6 of 8 patients). However, there was no statistical significance between the two groups. CONCLUSION: Stapes fixation was found in 78.9% of tympanosclerotic ossicular fixation. In management of tympanosclerotic stapes fixation, meticulous excision of tympanosclerotic plaques and removal of new bone formation around stapes footplate after adequate exposure could achieve a relatively good hearing result without stapes surgery.

Congenital Stapes Anomalies with Normal Eardrum

OBJECTIVES: A non-progressive and conductive hearing loss with normal eardrum, but no history of trauma and infection, is highly suggestive of a congenital ossicular malformation. Among ossicular anomalies, stapes anomaly is the most common. The purpose of this study is to describe patterns of stapes anomaly and to analyze its surgical outcome with special reference to its patterns. METHODS: We conducted a retrospective case review. The subjects comprised 66 patients (76 ears) who were decisively confirmed by the exploratory tympanotomy as congenital stapes anomalies without any anomalies of the tympanic membrane and external auditory canal. The preoperative and postoperative audiological findings, temporal bone computed tomography scan, and operative findings were analyzed. RESULTS: There were 16 anomalous patterns of stapes among which footplate fixation was the most common anomaly. These 16 patterns were classified into 4 types according to the status of stapes footplate. Successful hearing gain was achieved in 51 out of 76 ears (67.1%) after surgical treatment. CONCLUSION: Footplate fixation was usually bilateral, whereas stapes anomalies associated with other ossicular anomaly were usually unilateral. The success of the surgical treatment of stapes anomaly might depend on its developmental status of the footplate. Stapes anomalies were detected without any fixed patterns, therefore, it is quite possible to detect a large variety of patterns in future.

Postoperative Results of Ossiculoplasty over Stapes Head / 대한이비인후과학회지

BACKGROUD AND OBJECTIVES: Incus erosion with intact stapes head was most common ossicular impairment in chronic otitis media. Here, we aimed to investigate hearing and clinical results of the ossiculoplasties when the stapes head was intact. SUBJECTS AND METHOD: We analyzed 281 patients of ossiculoplasties over stapes head performed from 1990 to 2005. Patients were divided into 3 groups: Si group (n=121) included patients with interposition of prosthesis between malleus and stapes; Sc-PORP group (n=99) included patients with columellarization between tympanic membrane and stapes head with PORP; Sc-SC group (n=61) included patients with columellarization with the autologous materials between tympanic membrane and stapes head. Hearing improvement and extrusion rates of three groups were analyzed. RESULTS: At 6 months after the surgery, the postoperative air-bone gap (ABG) level within 20 dB was 45%, 44%, 25% in Si, Sc-PORP, Sc-Sc, respectively. The closure of ABG was statistically better in Si and Sc-PORP compared with Sc-SC. In canal wall-up mastoidectomy, Sc-PORP showed better hearing results than Si, while Si was better than Sc-PORP in canal wall-down mastoidectomy. At 36 months after the surgery, extrusion-free survival according to the type of ossiculoplasty were 100%, 89.6%, 100% in Si, Sc-PORP, Sc-SC, respectively. CONCLUSION: Si and Sc-PORP provide good hearing results. However, Si has lower extrusion rates than Sc-PORP and remains stable over time.

Results of Ossiculoplasty with Kurz Titanium Prosthesis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various materials have been used for ossicular reconstruction, but there have been no reports for titanium prosthesis in South Korea. The purpose of this study was to assess the hearing results of Kurz titanium prosthesis in chronic ear diseases. SUBJECTS AND METHOD: A retrospective review was made of 62 cases who underwent ossicular reconstruction using either titanium (TTP(R)-VARIO System) or plastipore (Polycel(R)) prosthesis from January 2003 to July 2005. Postoperative hearing results were analyzed taking in several prognostic factors such as the condition of middle ear mucosa and ossicle, or surgical method. RESULTS: A postoperative air-bone gap of E20 dB was obtained in 75.6% of the titanium and 56% of plastipore ossiculoplasty. The Postoperative ABG (air bone gap) show better results in healthy middle ear mucosa and in those cases which contain stapes superstructure. CONCLUSION: Titanium have a good biocompatibility and low extrusion rates with excellent hearing results. Besides, good visualization and accurate placement were easy to achieve.

Hearing Results of Ossiculoplasty Using Polycel(R) Prosthesis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: During the last decade, the surgical use of alloplasts has become more and more widespread among otologists. In this study, we evaluated the hearing results of ossiculoplasty using Polycel(R) prosthesis. SUBJECTS AND METHOD: One hundred eighty eight cases who underwent ossicular chain reconstruction using Polycel(R) prosthesis and had been followed up postoperatively for more than 12 months at Severance Eye-ENT Hospital from 1998 to 2002 were reviewed retrospectively. Postoperative hearing results were assessed by measuring the postoperative air-bone gap (ABG) and closure in air-bone gap. Successful postoperative ABG criteria were defined as the following three groups ; ABG of < or =10 dB, ABG of < or =20 dB, and ABG of < or =30 dB. Several prognostic factors such as the condition of middle ear mucosa and ossicles, presence or absence of cholesteatoma, surgical method, staging and revision surgery were analyzed. RESULTS: Of the total of 188 cases, 22 cases (11.7%) were < or =10 dB ABG, 96 (51.1%) cases were < or =20 dB ABG, and 158 (84.0%) cases were < or =30 dB ABG. The hearing results were good for healthy middle ear mucosa and cases which contained stapes superstructure, the hearing results were Good. CONCLUSION: Polycel(R) is a good material to be used in ossiculoplasty as a hydroxyapatite and autologous bone. In ossiculoplasty, good prognostic factors of the middle ear condition were healthy middle ear mucosa and the presence of stapes superstructure.

Ossiculoplasty in Difficulty: A Method to Improve Stability of TORP / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Primary goals of surgery for chronic ear disease are infection control and hearing restoration. When performing ossiculoplasty with total ossicular replacement prosthesis (TORP), it is difficult to keep the prosthesis stable. We intended to establish a method for stabilizing TORP in ossiculoplasty and to evaluate the results of the procedure. SUBJECTS AND METHOD: Thirty nine cases of ossiculoplasty performed between January 2000 and February 2003 were analyzed. The follow-up period was from 6 to 31 months (mean 13.1). The pure tone average threshold of the frequencies of 0.5, 1, 2, 3 kHz was used to evaluate results. The degree of hearing improvement, previous mastoid operation method, disease, and extrusion rate of prosthesis were analyzed. To stabilize the TORP, we made a hole in the tragal cartilage and put the shaft of the prosthesis into the hole. RESULTS: A successful hearing gain was defined as a postoperative air-bone gap of < or = 20 dB. According to this criteria, the success rate was 43.6%. Averages of pre and postoperative air conduction were 57.6 dB and 47.1 dB, respectively. The degree of hearing improvement according to the types of mastoid surgery were 48.1% and 33.3% for intact canal wall mastoidectomy and open cavity mastoidectomy, respectively. Four patients underwent reoperation. The findings were 2 cases of short TORP and 2 cases of empty middle ear space, but prostheses were stable in each case. There was one case of extruded prosthesis (2.6%). CONCLUSION: With our method, TORP was kept stable in the oval window niche. However, for hearing improvement, other factors such as middle ear mucosa status or Eustachian tube function are important and further investigation is needed.

A Case of Stapedectomy with Total Ossicular Replacement Prosthesis in Stapes Fixation without Malleus and Incus / 대한이비인후과학회지

This study was done on a case of chronic otitis media in both ears of a 47-year-old woman who received tympanization in the left middle ear in a local hospital three years ago. Ossiculoplasty was not tried in this case due to fixation of the stapes. However, conductive hearing loss of the left ear continued after tympanization, necessitating middle ear exploration. After the exposure of middle ear cavity, we found the absence of malleus and incus, and the fixation of stapes. Stapedectomy was carried out and total ossicular replacement prosthesis was also performed for the protection of the oval window by using perichondrium, cartilage and fascia. Postoperative bone conduction showed improvement of 15 dB, and air conduction showed improvement of 22 dB. After the operation, an average air-bone gap was improved within 10 dB. We experienced good hearing improvement without significant complications during the follow up period.

Comparison with Hearing Gains by the Different Methods of Operation in the Defect of Malleus and Incus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Multiple techniques of ossicular replacement have been advocated for hearing gain in the setting of chronic otitis media. The purpose of this study is to investigate hearing gain in the middle ear surgery according to the surgical technique and the materials. MATERIALS AND METHOD: Ninety-nine cases with ossicular replacement with mastoidectomy in the Konkuk University Hospital from 1995 to 2001 were reviewed retrospectively. Postoperative hearing gains were compared with the two methods of mastoidectomy and the two materials of ossicular replacement separately. RESULTS: A successful hearing gain was defined as a postoperative air-bone gap less than 30dB. According to this criterion, 47% of intact canal wall mastoidectomy cases and 43% of open cavity mastoidectomy cases were successful. Thirty-one percent of ossicular replacement case using cartilage-perichondrium and 62% using hydroxyapatite-PORP were successful. The extrusion rate was zero % in ossicular replacement using cartilage-perichondrium, and 57% in ossicular replacement using PORP. CONCLUSION: There was a significant differences in hearing gain and extrusion rate by using two different materials for ossicular replacement such as cartilage and hydroxyapatite-PORP (p0.05).

The Long Term Results of Ossicular Chain Reconstruction Using IONOS(R) in Chronic Otitis Media Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The goals in the surgery of chronic otitis media are to gain control of infection, closure of the tympanic membrane defects and hearing rehabilitation via ossicular chain reconstruction. Polymaleinate ionomeric cement, which has been used in dentistry as a filling and lute material for more than 15 years, has recently been used to construct total and partial ossicular prostheses. We intended to evaluate the hearing results of ossicular chain reconstruction using polymaleinate ionomeric prosthesis (IONOS(R)) in patients with chronic otitis media with the minimum 3 years postoperative follow-up periods. MATERIALS AND METHOD: Forty-four cases (30 PORP and 14 TORP), who underwent ossicular chain reconstruction using IONOS(R) in the Chonnam University Hospital from 1993 to 1996, were reviewed retrospectively. A postoperative hearing was accessed by the postoperative air-bone gap (ABG). Postoperative ABG was divided into the following three groups, ABG of or=31 dB. RESULTS: In the 44 total cases, 14 cases (31.8%) had

Short Term Hearing Results of Assembled Allograft Septal CartilageOssiculoplasty of PORP and TORP Configuration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various techniques of ossicular reconstruction have been advocated for hearing restoration in the chronic otitis media and cholesteatoma. Although cartilage has good biocompatibility to minimize extrusion or displacement, and is readily available, versatile to use, the hearing results with cartilage graft are poorer than that with plastic materials. The author believed this was due to the sculpturing problem of cartilage, and has devised an assembled type of cartilage ossiculoplasty of PORP and TORP configuration. The technique and short term results are reviewed. METHODS: Of the patients who underwent ossiculoplasty between 1998 and 2000, 103 ears of 95 patients, aged 3-66 years (mean 38.9) were analysed retrospectively. The follow-up period was from 3 to 30 months (mean 9.5). Fifty-one ears were found to be in the second stage and 52 ears were in the first stage. Allograft septal cartilage was sculptured separately and assembled as head and shaft. The average threshold in the frequencies of 500, 1000 and 2000 Hz was used for determination of results. RESULTS: The preoperative mean air-bone gap (ABG) was 42.86+/-8.79 dB and postoperative ABG was 21.22+/-11.33 dB. Gain of ABG was 21.63+/-11.11 dB. Closure of the ABG to within 10 dB, 20dB and 30 dB were achieved in 25.24%, 55.34% and 83.50% respectively. Gain of the ABG did not differ between the one staged and the two staged ossiculoplasty. Patency of eustachian tube orifice and presence of superstructure of stapes did influence the hearing results of this type of ossiculoplasty. CONCLUSION: The assembled type of cartilage ossiculoplasty of PORP and TORP configuration with allograft septal cartilage ossiculoplasty shows satisfactory short term hearing results and represents an excellent alternative to biocompatible prosthesis for ossicular recon-struction.