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.

The application of autologous conchal cartilage in ossicular chain reconstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the efficiency of autologous conchal cartlage in ossicular chain reconstruction in patients with chronic suppurative otitis media.@*METHOD@#Seventy-three cases of chronic suppurative otitis media (COM) with or without cholesteatoma who had undergone mastoidectomy with tympanoplasty and ossicular chain reconstruction(OCR) using autologous conchal cartilage as prosthesis were studied retrospectively. Sixty-six cases of COM who had undergone mastoidectomy with tympanoplasty and without OCR were studied as control. The examination of pure tone hearing level of air conduction(AC) and bone conduction(BC) was done before operation, 2 months and 6 months after operation respectively. The pure tone average (PTA) of 0.5, 1.0, 2.0 kHz was observed.@*RESULT@#The average air conduction gain was more than 15dB or the PTA (AC) was less than 25 dB 2 months after operation in 35 out of 73 cases who had undergone OCR. Nevertheless, the data became 56 out of 73 cases 6 months after operation. In the control group, The average air conduction gain was more than 15dB or the PTA(AC) was less than 25 dB 2 months after operation in 10 out of 66 cases who had not undergone OCR. The data became 14 out of 66 cases 6 months after operation. In OCR group, air bone gap(ABG) was less than 20 dB in 39 cases 2 months after operation and in 57 cases 6 months after operation. In the control group without OCR, ABG was less than 20 dB only in 11 cases 2 months after operation and in 16 cases 6 months after operation. By statistically analysis, there was significant difference of postoperative hearing improvement between the two groups.@*CONCLUSION@#The autologous conchal cartilage can be used as the material of prosthesis for ossicular chain reconstruction in the operation of chronic otitis media. It has many advantages, such as easily--obtained, good histocompatibility, easy to shape and so on.

Effect of ossicular chain reconstruction with titanium ossicular replacement prosthesis in mastoidectomy with synchronous ossiculoplasty / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To assess hearing effect of ossicular chain reconstruction with titanium ossicular replacement prosthesis during mastoidectomy with synchronous ossiculoplasty in chronic middle ear disease.@*METHOD@#Retrospective reviews were performed for 139 patients who had underwent mastoidectomy and tympanoplasty with titanium ossicular replacement prostheses at the same time between 2008 and 2011. The partial ossicular replacement prostheses (PORP) were used in 91 patients and the total ossicular replacement prostheses (TORP) were used in 48 patients respectively. All patients had follow-up for 2 to 5 years. The preoperative and postoperative mean air conduction and air-bone gaps(ABG) for the four frequencies (0.5, 1.0, 2.0 and 4.0 kHz) were evaluated. The improvement of mean air conduction and ABG over the same frequencies were measured. A postoperative ABG less than or equal to 20 dB was considered a successful operation. The hearing results of titanium PORP and TORP were compared.@*RESULT@#The mean air conductions were (53.97 +/- 11.32)dB and (36.80 +/- 11.68) dB preoperatively and postoperatively in PORP group. The mean improvement in air conduction was (17.17 +/- 5.79)dB. The mean ABG was (31.84 +/- 6.17)dB and (15.13 +/- 7.22)dB preoperatively and postoperatively in PORP group. The mean improvement in ABG was (17.71 +/- 5.5)dB. The difference of hearing threshold between preoperative and postoperative had statistical significance (P < 0.01). The mean air conduction were (58.05 +/- 11.35)dB and (44.53 +/- 13.15)dB preoperatively and postoperatively in TORP group. The mean improvement in air conduction was (13.52 +/- 7.81)dB. The mean ABG; were (35.67 +/- 5.73)dB and (21.48 +/- 7.01)dB preoperatively and postoperatively for TORP group. The mean improvement of hearing threshold in ABG was (14.18 +/- 7.53)dB. The difference of hearing threshold between preoperative and postoperative had statistical significance (P < 0.01). ABG less than 20 dB after operationwas happened in 68.63% of the patients (74.73% for PORP and 54.17% for TORP). There was statistically significant difference between PORP and TORP (P < 0.05).@*CONCLUSION@#We conclude that titanium ossicular reconstruction during mastoidectomy with synchronous ossiculoplasty give stable and excellent hearing results. We obtained better results with PORP than with TORP.

The impact of malleus processing in ossicular chain reconstruction on the therapeutic effect in patients with tympanosclerosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the effect of different malleus treatments on the postoperative efficacy in the tympanosclerosis patients receiving ossicular chain reconstruction.@*METHOD@#Fifty-nine patients (62 ears) with tympanosclerosis were treated by ossicular chain reconstruction. All the patients were divided into three groups, including malleus removal group (A, 24 ears), retaining only the malleus handle group (B, 18 ears) and the intact malleus group (C, 20 ears). All the patients were followed up 3 months pre-operation, 3 months and 1 year post-operation by audiometric measurement (the average hearing threshold at 0.5, 1.0, 2.0 kHz HI). Tympanic membrane was examined by ear endoscope.@*RESULT@#The pre-operation mean air bone gap (ABG) in these groups were 40.07 +/- 77.56 dB, 37.31 +/- 76.45 dB, and 36.75 +/- 76.72 dB, among which the difference had no statistical significance (P > 0.05). At 3 months after operation, the ABG in all cases was improved at 0.5, 1 and 2 kHz. The difference of ABG improvement among these three groups had no statistical significance (P > 0.05). One year after surgery, the ABG of the three groups were decreased by 17.92 +/- 9.28 dB, 16.76 +/- 5.19 dB and 10.58 +/- 7.38 dB respectively. The hearing improvement in group C is less than the other two groups (P = 0.03, P = 0.016). The difference of hearing improvement between group A and group B had no statistical significance(P > 0.05). Group A and group B each have one case of tympanic membrane perforation and artificial ossicle falling off.@*CONCLUSION@#The operating processes of malleus in ossicular chain reconstruction of patients with tympanosclerosis were introduced. In terms of short-term efficacy, the three groups showed no significant difference. However, the long-term efficacy of the patients in the group A and group B were better compared with the group C.

Efficacy observation of auditory reconstruction using three different materials in ossiculoplasty and mastoidectomy to treat chronic otitis media / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the effects of different types of prosthesis used in ossiculoplasty on mastoidectomy of treating chronic otitis media.@*METHOD@#One hundred and forty three patients with chronic otitis media were treated by canal wall-down tympanoplasty with ossiculoplasty in a single stage. According to material of prosthesis, they were classified as titanium group (group A, 52 cases), hydroxypatite group (group B, 47 cases) and autogenous bone group(group C, 44 cases). The postoperative complication and hearing thresholds were analyzed in the 24 months follow-up. Average postoperative air-conduction gain and air-bone gap were measured at four frequencies: 0.5, 1.0.2, and 4.0 kHz.@*RESULT@#12-month after operation, the average air threshold and air-bone gaps of the three groups were reduced (P < 0.05). The reconstruction successful rate (78.7%) of group A was slightly better than that of B, C (68.1%, 70.4%), there was no statistically significant difference. The difference of the average air threshold and air-bone gaps of group B, C after 24-month of operation and 12-month after operation was statistically significant (P < 0.05). The reconstruction successful rate (48.9%, 45.5%) of group B, C was lower than that of A (76.9%), the difference was also statistically significant (P < 0.05).@*CONCLUSION@#Prostheses using titanium type could give good functional results and strong stability with low complication.

Diagnosis and treatment of traumatic ossicular chain disruption and dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the diagnose therapy and the postoperative curative effect of traumatic ossicular chain disruption and dislocation.@*METHOD@#Eight cases (8 ears) with traumatic ossicular chain disruption. Six cases of unilateral conductivity deafness, 2 of mixed deafness still with conductive primarily. Eight ears all were performed tympanic exploration and ossicular replacement prosthesis, 1 ear with TORP (total ossicular replacement prosthesis). 4 ears with PORP (partial ossicular replacement prosthesis), 2 with ossicular chain reset, 1 with artificial incus reconstruction. The treatment effect was compared by the preoperative and postoperative ABG (air bone gap).@*RESULT@#Preoperative average ABG was 42. 9 dB, the average ABG 3 weeks after operation was 22.3 dB, which reduced 20.6 dB compared to the preoperative, having a statistically significant difference (t = 22.10, P < 0.01). The average ABG was 18.6 dB 6-8 months after operation, which reduced 24.3 dB compared to the preoperative, having a statistically significant difference (t = 12.813, P < 0.01).@*CONCLUSION@#The conductivity hearing loss after traumatic ossicular chain disruption or dislocation is preferred operation treatment, and replacement should use different ways according to the operation in case, and the hearing improvement was obvious.

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.

Therapeutic effect of ossicular reconstruction with bioceramic or porous macromolecular polyethylene partial ossicular replacement prosthesis in patients with tympanosclerosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of ossicular reconstruction with partial ossicular replacement prosthesis (PORP) in patients with tympanosclerosis.</p><p><b>METHODS</b>The data of 31 cases of tympanosclerosis treated between 1992 and 2009 were reviewed. Of the 31 patients, 17 (17 ears) underwent ossicular reconstruction with porous macromolecular polyethylene PORP, and 14 (14 ears) with bioceramic PORP. All the patients were followed up for 3-24 months.</p><p><b>RESULTS</b>Significant improvement was found in postoperative speech frequency (500, 1000, 2000 Hz) pure tone average (PTA) and air-bone gap (ABG) (P < 0.05) after the treatments without statistically significant differences between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Porous macromolecular polyethylene and bioceramic are valuable ossicular prosthesis for tympanosclerosis.</p>

Biosilicate® Ototoxicity and Vestibulotoxicity evaluation in guinea-pigs / Avaliação da ototoxicidade e vestibulotoxicidade do biosilicato® em orelhas de cobaias

Changes, destructions and interruptions in middle ear ossicular chain architecture may be caused by infection, trauma, tumors, congenital alterations or prior surgeries. Nonetheless, infectious and inflammatory processes, focal or generalized which affect the middle ear are the most prevalent, causing a great demand for ossiculoplasty. Biosilicato® is a new material which can be used in the middle ear with the goal of reconstructing the ossicular chain. It is a bioactive type A vitroceramic, in other words, it binds to bone or soft tissue in a matter of a few hours, thanks to the formation of hydroxy-carbonateapatatie in its contact surface when in contact with body fluids. AIMS: The goal of the present paper is to assess biosilicate ototoxicity and vestibular toxicity in experimental animals, for later use in humans. MATERIALS AND METHODS: This a clinical and experimental study in which otoacoustic emissions were performed before and after the placement of Biosilicate in the middle ear of experimental animals and a scanning electron microscopy was carried out in the cochlea, saccule, utriculus and macula of the semicircular canals after 30 and 90 days to assess oto and vestibular toxicity. RESULTS: There were no signs of oto or vestibular toxicity in any of the groups associated with biosilicate. CONCLUSION: Biosilicate is a safe material to be used in ossiculoplasties

As alterações, destruições e interrupções da arquitetura da cadeia ossicular da orelha média podem ser causadas por infecções, trauma, tumores, alterações congênitas ou cirurgias prévias. Entretanto os processos inflamatórios e infecciosos, focais ou generalizados que acometem a orelha média são os mais prevalentes, gerando uma enorme demanda de ossiculoplastias. O Biosilicato® é um novo material que pode ser usado em orelhas médias com o objetivo de reconstruir a cadeia ossicular. Constitui-se de uma vitrocerâmica bioativa do tipo A, ou seja, que se liga a tecido ósseo ou a tecido mole em algumas horas, devido à formação de hidroxicarbonatoapatita em sua superfície de contato quando em contato com fluidos corpóreos. OBJETIVO: O objetivo deste trabalho é avaliar a ototoxicidade e vestibulotoxicidade do Biosilicato em cobaias, para posterior utilização em humanos. MATERIAL E MÉTODO: Trata-se de um estudo clínico e experimental, onde foram realizadas emissões otoacústicas antes e após a colocação de Biosilicato na orelha média de cobaias e realizada microscopia eletrônica de varredura da cóclea, sáculo, utrículo e máculas dos canais semicirculares após 30 e 90 dias para avaliar a oto e vestibulotoxicidade. RESULTADOS: Não houve sinais de oto ou vestibulotoxicidade em nenhum dos grupos relacionados ao Biosilicato. CONCLUSÃO: O Biosilicato é um material seguro para ser usado em ossiculoplastias.

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.

Observation of bridging operation by an autogenous incus in the ossiculoplasty / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical effects of bridging operation by an autogenous incus in the ossiculoplasty.</p><p><b>METHODS</b>All the postoperative follow-up data of the 68 patients were analyzed retrospectively, who underwent bridging operation by an autogenous incus in the ossiculoplasty and were followed up for 6-28 months with an average of 19.75 months. The autogenous incus which had been reshaped was implanted between the intact malleus and the intact mobile stapes. The preoperative and postoperative pure tone average (PTA) air-conduction, bone-conduction and air-bone gap on four frequencies (0.5, 1, 2 and 4 kHz) were calculated and analyzed.</p><p><b>RESULTS</b>No postoperative autogenous includes were extruded with only two cases displaced. The pure tone air conduction improved from a preoperative average of (46.69 +/- 18.32) dB to a postoperative average of (30.21 +/- 9.46) dB, while bone conduction improved from a preoperative average of (24.72 +/- 10.63) dB to a postoperative average of (18.15 +/- 8.91) dB, as well as air-bone gap closed from a preoperative average of 21.97 +/- 10.32 dB to a postoperative average of (12.06 +/- 9.46) dB. The success rate (postoperative PTA-ABG < or = 20 dB) occurred in 75% of all the cases. The improvement of the bone conduction occurred in 66% of all the cases, at least with 10 dB occurred in at least two frequencies.</p><p><b>CONCLUSIONS</b>Because of low expenses, high convenience in an operation, high stability in effects, very low complications and excellent hearing results for the patients, the bridging operation as stated in the above was worthy of choice. The autogenous incus could be utilized if the defects between the intact, mobile stapes and the intact malleus could be well repaired.</p>

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.

Results with a new type ossicular prostheses mixed bone morphogenetic protein and hydroxyapatite / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the results in patients who had ossicular chain reconstruction with a new type ossicular prostheses mixed bone morphogenetic protein and hydroxyapatite.@*METHOD@#Analyze The effect of ossiculoplasty were analyzed in 59 cases. Ossiculoplasty using HA-BMP prostheses was performed in 26 ears,PORP was performed in 19 ears, TORP was performed in 7 ears.@*RESULT@#The hearing success rate was 92.3% of 26 ears and no extrusion were found in HA-BMP group. There was a significant difference in mean postoperative air-bone gap between HA-BMP prostheses and autograft bone.@*CONCLUSION@#The new type HA-BMP prostheses can provide stable hearing results with high success rate over time.

Cirurgia de reconstrução de orelha média / Middle ear reconstruction

A orelha média funciona como um amplificador sonoro. Utiliza para isso três mecanismos: o hidráulico, a alavanca dos ossículos e o jogo das janelas, sendo o mais importante o fato da energia mecânica captada pela membrana timpânica ser concentrada na área da janela oval, que é muitas vezes menor (mecanismo hidráulico). Podemos dividir o não funcionamento da cadeia ossicular em duas categorias: com diminuição da vibração da cadeia e com interrupção da cadeia. Neste artigo, o autor discorre sobre os problemas da cirurgia de reconstrução.

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.

Bone cement in ossiculoplasty

This study included 30 patients having conductive hearing loss secondary to chronic otitis media with ossicular discontinuity. Biocompatible polymethylmethacrylate [PMMA] bone cement was used as a locally manufactured prosthesis for ossicular reconstruction in the forms of PORP and TORP. In ears with intact stapes superstructure, PORP was used [18 cases]; while, in ears with absent stapes superstructure, a similar TORP was used [12 cases]. The postoperative mean air-bone gap gain was 20 dB at the speech frequencies of 500 Hz-1000 Hz, 2000 Hz-4000 Hz in 22 cases. An extrusion of the prosthesis occurred in two cases. It was concluded that this locally made prosthesis is efficient in closing air-bone gap as well as cost- effective

Bioactive glass ossicular reconstruction

This study had been done for 20 patients suffering from conductive hearing loss due to ossicular discontinuity. The discs made of bioactive glass composite for ossicular reconstruction was used. Observation period ranged from 0.5-3 years during which follow up for perforations of the tympanic membrane over the implants or rejection of the prosthesis from the middle ear was done together with the audiological outcome. The study concluded that ossicular chain defects repair using the bioactive glass composite is an efficient technique with minimal morbidity and excellent results

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).