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ABSTRACTS

KURZ IMPLANTS, PRECISION INSTRUMENTS, VENTILATION TUBES

MIDDLE EAR SURGERY

T TP - VARIA C S Y S TEM Titanium implants in middle ear surgery were introduced in the late 90s
and are now frequently used in middle ear surgery. However, long-term
studies of patient outcome are few and have only been published in sub-
Middle Ear Reconstruction Using the Titanium groups of patients. We report the long-term effect of titanium middle ear
Kurz Variac Partial Ossicular Replacement Prosthesis implants for ossicular reconstruction in chronic ear disease investigated in
a Norwegian tertiary otological referral centre. Retrospective chart reviews
Meulemans J., Wuyts F. L., Forton G. E. J. were performed for procedures involving 76 titanium implants between
2000 and 2007. All patients who underwent surgery using the Kurz Vario
Published: JAMA Otolaryngol Head Neck Surg. 2013 Oct titanium implant were included in the study. Audiological parameters using
139(10):1017-25. DOI: 10.1001/jamaoto.2013.4751 four frequencies, 0.5, 1, 2, and 3 kHz, according to AAO-HNS guidelines,
was assessed pre and postoperatively. Otosurgical procedures, complica-
Importance: Satisfactory functional results following ossicular chain re- tions, revisions, and extrusion rates were analyzed. The study had no drop-
construction mainly depend on a stable connection between the tympanic outs. The partial ossicular replacement prosthesis (PORP) was used in 44
membrane and the stapes, which is in turn dependent on the type of prosthe- procedures and the total ossicular replacement prosthesis (TORP) in 32
sis used. Knowledge about the safety and functional outcome of the com- procedures, respectively. Mean follow-up was 5.2 years (62 months). The
mercially available middle ear prostheses is therefore of great importance. ossiculoplasties were performed as staging procedures or in combination
with other chronic ear surgery. The same surgeon performed all the proce-
Objective: To evaluate the efficacy and safety of the Kurz TTP-Variac dures. A postoperative air-bone gap of ≤ 20 dB was obtained in 74 % of
System partial ossicular replacement prosthesis (PORP) in ossiculoplasty. the patients, 82 % for the Bell (PORP) prosthesis, and 63 % for the Arial
(TORP) prosthesis. The extrusion rate was 5 %.
Design, Setting and Participiants: Retrospective review of all ossicu-
loplasties performed by 1 surgeon at a secondary referral center from Au- We conclude that titanium ossicular implants give stable and excellent long-
gust 2006 through July 2012. Participants were patients with cholesteato- term hearing results.
ma, chronic otitis media, or ossicular chain disruption in the absence of
inflammatory disease who underwent ossicular reconstruction.
Variable length titanium prostheses for
Exposure: Ossiculoplasty using a Kurz TTP-Variac System PORP. type III tympanoplasty. Intraoperative length adjustment
and fixation of the cartilage overlay
Main Outcome and Measures: Mean preoperative and postoperative
air-bone gaps (ABGs) and improvements in ABG were analyzed for each Zenner H.-P., Zimmermann R., Steinhardt U., Maassen M. M.
frequency by means of a 4-frequency pure-tone average. Successful post-
operative hearing was defined as postoperative ABG smaller than 20 dB. Published: HNO 01 Apr 2006, 54(4):298-302 (German)
DOI: 10.1007/s00106-006-1391-x
Results: Eighty-nine ears in 83 patients aged 7 to 85 years were included.
Transmeatal tympanoplasty was performed in 17 ears (19%). Seven ears Introduction: For type III tympanoplasty by partial ossicular replacement
(8%) underwent tympanoplasty with canal wall-down mastoidectomy, and prosthesis (PORP) or total ossicular replacement prosthesis (TORP), the
65 ears (73%) underwent canal wall-up (combined approach) tympano- length of the prosthesis must match the individual intraoperative anatomical
plasty with mastoidectomy. The study population comprised 61 primary and physiological characteristics.
tympanoplasties (69%) and 28 revision cases (31%). Mean follow-up was
13 months. Overall, the ABG significantly improved from a mean (SD; Materials and Methods: Databanks were used to determine the necessary
range) of 26.19 (11.53; 3.75-51.25) dB to 15.58 (9.80; 0-48.75) dB (P < sizer length of the sizer disc. The measurement template for the size of the
.01 for all frequencies). Mean ABG improvement was 10.62 dB. Success- cartilage to overlay the prosthesis headplate was derived from the headplates
ful postoperative hearing was obtained in 65 ears (73%). Revision surgery, of the Tuebinger titanium prostheses (TTP®) and the Dresdener titanium
especially in ears with ossicular chain disruption without inflammatory prostheses. Finally all functions were integrated into a synthetic plate.
disease, was associated with poorer functional outcome, whereas pres-
ervation of the malleus was associated with a better functional outcome Results: The result was a simple and reasonably priced disposable multi-
(P < .05). There were few complications (1 prosthesis extrusion, 2 pros- functional instrument (Tuebinger sizer disc TSD) which allowed an exact
thesis dislocations, 2 reperforations, 3 cases of residual cholesteatoma, and measurement for every prosthesis in TORP and PORP. For the TTP®-
3 of light sensorineural hearing loss). Variac, the TSD enabled the simple intraoperative production of prostheses with
the length desired by the surgeon. For PORP the TSD enabled an adaptation of
Conclusion and Relevance: The titanium Kurz TTP-Variac System PORP the diameter of the prosthesis foot for TTP®, TTP®-Vario and TTP®-Variac
is an effective prosthesis to reconstruct the ossicular chain. Complications and provided a template for the size determination of the cartilage overlay of
are rare, illustrating the safety of the prosthesis. the titanium prosthesis head. The sizers and the resulting prostheses were used
for initial tympanoplastic operations. Audiometric investigations carried out
6 weeks postoperatively gave results corresponding to those previously ob-
Long-term hearing result using Kurz titanium ossicular implants tained in a study with TTP® and TTP®-Vario using the old instrumentation.

Hess-Erga J., Møller P., Vassbotn F. S. Conclusions: The new instrumentation leads to an improvement of the
intraoperative practicability and a simplification. The audiological results
Published: European Archives of Oto-Rhino-Laryngology, May 2013 remain the same.
DOI: 10.1007/s00405-012-2218-x

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