Ossicular chain reconstruction: endoscopic or microscopic?

OBJECTIVE: To compare the results of endoscopic and microscopic ossicular chain reconstruction surgery. METHODS: Patients undergoing ossicular chain reconstruction surgery via an endoscopic (n = 31) or microscopic (n = 34) technique were analysed for age, gender, Middle Ear Risk Index, ossicular chain defect, incision type, ossicular chain reconstruction surgery material, mean air conduction threshold, air-bone gap, air-bone gap gain, word recognition score, mean operation duration and mean post-operative follow up. RESULTS: Post-operative air conduction, air-bone gap and word recognition score improved significantly in both groups (within-subject p < 0.001 for air conduction and air-bone gap, and 0.026 for word recognition score); differences between groups were not significant (between-subject p = 0.192 for air conduction, 0.102 for air-bone gap, and 0.709 for word recognition score). Other parameters were similar between groups, except for incision type. However, endoscopic ossicular chain reconstruction surgery was associated with a significantly shorter operation duration (p < 0.001). CONCLUSION: Endoscopic ossicular chain reconstruction surgery can achieve comparable surgical and audiological outcomes to those of microscopic ossicular chain reconstruction surgery in a shorter time.

The Stapes Prosthesis: Past, Present, and Future.

Since the original carved Teflon stapes over vein graft, stapedectomy prostheses have undergone evolution. Prostheses shapes, materials, and surgical techniques for placement have reflected advances in biomaterials and surgical tools. The variability in prostheses has reflected alternative techniques of stapedectomy and stapedotomy and differing strategies for attachment to the incus. Although many iterations of stapes prostheses have been proposed, excellent results can be achieved with various prostheses designed to rest on tissue grafts in stapedectomy techniques or pass through the footplate in stapedotomy techniques when used by surgeons experienced with technique details specific to the selected prosthesis.

Next generation shape memory prosthesis (NiTiBOND) for stapedotomy: Short-term results.

OBJECTIVES/HYPOTHESIS: To review hearing results and complications for the NiTiBOND next generation shape memory prosthesis and compare them with results for the current shape memory prosthesis (SMart). STUDY DESIGN: Retrospective, multicenter chart review. METHODS: Primary laser stapedotomy was performed using either a NiTiBOND or a SMart prosthesis. Ninety-two ears in 79 patients were included in the study (67.4% female), 52 with the NiTiBOND prosthesis and 40 with the SMart prosthesis. Data collected included demographic variables, pre- and postoperative pure-tone air and bone conduction thresholds, speech discrimination scores, complications, and the need for revision surgery. Pure-tone average (PTA) and PTA air-bone gap (ABG) pre- and postoperative were computed. Success was defined as a postoperative ABG of ≤10 dB. RESULTS: There were no significant differences between groups in hearing results, including improvement in ABG, change in speech discrimination, change in air or bone PTA, or change in high-frequency bone PTA. Short-term (mean = 4.4 and 4.9 weeks, respectively) success rates for the NiTiBOND and SMart prostheses were 84.6% and 70.0%, respectively, with this difference closing at the most recent test (83.7% and 80.0%, respectively). No revision surgery took place in either group, and there were no differences in complications such as dizziness, tinnitus, or taste disturbance, though the NiTiBOND group tended to have a lower rate of transient or permanent vertigo. CONCLUSIONS: Compared with the SMart prosthesis, the NiTiBOND prosthesis is a safe prosthesis that achieves at least comparable hearing results and may offer some surgical advantages. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:915-920, 2017.

Hearing aids: a review of what's new.

OBJECTIVE: To review the recent innovations in hearing aid technology. STUDY DESIGN: Review of the literature. SETTING: Private tertiary referral otology/neurotology practice. RESULTS: Recent innovations including digital signal processing (DSP), directional microphone technology, and open mold hearing aid fitting have resulted in improved satisfaction with current hearing aids. CONCLUSION: Current hearing aid technology with its innovations better meet needs of individuals who are hard of hearing. SIGNIFICANCE: The image commonly held of hearing aids by the general public is a negative one that can be improved with greater education.

What future in the 21st century for tibial bone allografts in ossicular chain reconstruction: the state of the issue.

After using tibial cortical bone allografts in reconstructing the middle ear over a period of ten years, the authors analyze their results. They compare the functional and anatomical outcome at 4 years of 24 patients who received this allografts with a series of 25 patients who underwent incus transposition. Results were analyzed in two different ways: the Air Bone Gap and the Glasgow Benefit Plot. The discussion addresses the techniques used to reduce risks of iatrogenic transmission of viruses and prions, the current legislation in Belgium and the comparative costs, after refunding of the various reconstruction materials. The authors conclude that, because the present-day preparation techniques offer a certain security with regard to transmission risks and because of its numerous advantages (mechanical properties, tolerance, cost and availability), tibial cortical bone still has a promising future.

[Three years of experience with titanium implants in the middle ear]. / Titan-Prothesen im Mittelohr. 3-Jahres-Erfahrungsbericht.

BACKGROUND: In continuation of our previously published report on initial experience with titanium implants in the middle ear [13], we now present the results of routine use over a three year period. METHODS: From November 1994 to November 1997, 661 titanium implants (Düsseldorf model) were implanted in the authors' clinics (355 PORP, 306 TORP). There was no preselection of patients. Five hundred eighty-two follow up examinations were performed with a medium follow up time of 11.6 months. RESULTS: The good initial results of the previous study with respect to biocompatibility and functional hearing results were confirmed in the long term follow-up. The average air-bone gap was calculated over the frequencies 0.5, 1, 2, and 4 kHz. Closure to within 20 dB was achieved in 72% of cases. The air-bone gap tended to decrease with increasing time of implantation. Adverse reaction to the prostheses did not occur. Extrusion occurred in one case of complete middle ear atelectasis with resorption of the interposed cartilage. Insufficient improvement of hearing was attributable to a short implant in 12 cases (1.8%). In three cases (0.5%) insufficient stability of the PORP was attributable to eroded stapes suprastructure, and in three others (0.5%) a dislocation was responsible for a poor hearing result. Middle ear fibrosis with impairment of sound transmission was seen in 3 patients (0.5%). CONCLUSION: The superior acoustic properties of the delicate yet rigid low-weight titanium implants combined with excellent biocompatibility lead to a good hearing result if a meticulous surgical technique is employed. The easy handling makes it a pleasure to work with these protheses.

Results and outcomes in ossiculoplasty.

This article presents a series of goals and questions for future research in ossiculoplasty. Important technical questions include what are the best materials, prosthesis shapes, and techniques of placement for both immediate and long-term success. Important clinical questions include what improvements in communication should we expect, how should cases be selected, and how should patients be counseled. There are many variables that could affect reported results, including the selection of cases, audiometric techniques, the frequencies of hearing measurement, and the methods of data analysis. These are all discussed in this article.