ABSTRACT
BACKGROUND: Titanium is a well-established implant material, and its use in ossicular chain reconstruction during middle ear surgery is increasing. HYPOTHESIS: Bony fixation of titanium prostheses has to be considered using this material. Contact with bony structures of the middle ear may result in immobilization. In revision procedures, there is a potential risk of damaging or extracting adherent structures such as the stapes. METHODS: This is a case report of an accidentally extracted stapes resulting from bony fixation of a titanium prosthesis in revision tympanoplasty. The surgical specimen was examined by microscopy, histology, and scanning electron microscopy. Energy dispersive x-ray analysis was used to confirm the elemental composition of the extracted stapes and the titanium prosthesis. RESULTS: The prosthesis showed good biocompatibility at the implantation site, with signs of bone resorption of the stapes suprastructure. However, bony fixation of the undersurface of the prosthesis foot to the stapes footplate was confirmed by ultrastructural analysis. CONCLUSION: In revision tympanoplasty, bony fixation of the titanium prosthesis should be considered.
