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Ossiculoplasty with KURZ titanium prosthesis Published: 24th Politzer Meeting 31 August – 4 September 2003, Amster-
dam, the Netherlands: Selected Abstracts
Nguyen D.-Q., Morel N., Dumas G., Troussier J., Lavieille J.-P.,
Schmerber S. Titanium has been an accepted prosthetic material for decades in cra-
niofacial and orthopaedic surgery. The last decennium, studies were
Published: Ann Otolaryngol Chir Cervicofac. 2005 Sep;122(4):187-93. published reporting the results of titanium prostheses used for ossicu-
(French) loplasty. The new. lightweight titanium prostheses are designed to maxi-
mize visualization of the capitulum and footplate region. Mechanical-
Objectives: Report the functional and anatomic results of ossicular recon- ly they are characterized by a high degree of rigidity and low weight.
struction by titanium prosthesis. Acoustically they have low sound damping, low acoustic impedance,
and a second resonance that might increase to broadband frequen-
Materials and Methods: Retrospective chart reviews were performed for cy transmission. These characteristics suggest the possibility of im-
111 patients who had undergone titanium ossicular implants between No- proved signal transfer in the main speech frequencies at around 2 kHz.
vember 1998 and 2002 (61 PORP, 50 TORP). The anatomical and audio- A prospective clinical study was started to evaluate the efficacy of the vari-
metric data were analyzed on average at 3 and 20 months. able (= adjustable length) Tübingen titanium prosthesis (TTP-Vario). Twen-
ty patients were evaluated. A canal wall up procedure was performed in 3
Results: At 20 months, the improvement of air-bone-gap mean was 12.7 cases, a canal wall down procedure in 17 cases. A postoperative air bone gap
dB with better results at low frequencies. The global success rate was 66% of < 20 dB was obtained in 60% of bell prosthesis patients and < 25dB in
(PORP 77%, TORP 52%). It decreased significantly in the open techniques. all bell prosthesis patients. The pure-tone average air-bone gap for the aerial
Extrusion rate was low (2/111) and the labyrinthization rate was 3.6%. prosthesis was < 20 dB in 43%, < 25 dB in 64% and < 30 dB in 85% at 1
Twenty patients required a surgical revision (18%). In 9 patients, the pros- month. The results were stable or improved for later time intervals. To date
thesis was too short. At long-term follow-up, the gains were stable in 60 there have been no extrusion. The surgeon finds the prosthesis easy to han-
patients, improved in 32 patients and worsened in 19 patients. dle and the open head of the prosthesis facilitates correct placement on the
capitulum of the stapes or on the footplate. From a surgical point of view,
Conclusion: The success rate is higher in the group of the PORP with the the Kurz titanium prosthesis is an excellent middle ear prosthesis due to the
closed technique. The stability of the TORP in open technique still remains design and the possibility of individual adjustment. The hearing results are
problematic. In all cases, the risk of extrusion requires a large cartilage graft good. Further studies are needed to confirm long-term efficacy.
recovering the plate of the prosthesis. The high rate of luxation (9/111 pros-
thesis too short) has led us to increase slightly the length of the prosthesis
(+1.22 mm mean).
T TP -TUEBINGEN TYPE PROS THESIS

T TP - VARIO S Y S TEM Ossiculoplasty With Titanium Prosthesis
Martins J., Silva H., Certal V. F., Amorim H., Carvalho C. F.
Synchronous ossiculoplasty with titanium prosthesis
during canal wall down surgery for advanced cholesteatoma: Published: Acta Otorrinolaringológica Española. Accepted 27 February 2011
anatomical and hearing outcomes DOI: 10.1016/j.otoeng.2011.02.004

Iseri M., Ustundag E., Ulubil S. A., Ozturk M., Bircan O. Objectives: The goal of this study was to make a review of the patients who
underwent Ossicular chain reconstruction with titanium prosthesis during
Published: The Journal of Laryngology & Otology (2012), 126, 131–135. an 8-year period in our Department.
DOI: 10.1017/S0022215111002520
Methods: A retrospective study was made on the ossiculoplasty cases
Objective: To analyse patients with cholesteatoma undergoing canal over a period of eight years in a Public Hospital District. The information
wall down mastoidectomy together with ossicular reconstruction with a was extracted by clinical process consultation. Between 1999 and 2008,
titanium prosthesis, in order to identify factors associated with hearing 124 ossiculoplasties using Kurz® titanium prosthesis for chronic otitis
outcomes. media were performed (78 partial ossicular chain reconstructions and 46
total Ossicular chain reconstructions). The single stage, staged and revi-
Study Design: Retrospective review of 97 cases undergoing single-stage sion ossicular chain reconstruction were included in the analysis. All pa-
surgical management. tients had a minimum of 6-month postoperative follow-up (mean 3 years
and 4 months). Comparisons of preoperative and postoperative pure tone
Methods: All patients underwent canal wall down mastoidectomy. Kurz averages were performed. Air-bone gap and implant extrusion rates were
titanium ossicular prostheses were used for ossicular chain reconstruction. measured. The success of the reconstruction was defined as a postopera-
Pre-operative and post-operative air conduction and bone conduction hear- tive air-bone gap (ABG) of 20 dB or better.
ing thresholds were obtained at 500, 1000, 2000 and 3000 Hz.
Results: Successful ossiculoplasty was obtained in 73.1% of partial ossicu-
Results: The mean pure tone average improved from 46.02 ± 14.54 dB lar chain reconstructions and 30.4% of total ossicular chain reconstructions
pre-operatively to 29.32 ± 14.64 dB postoperatively, for both total and (P < 05). The postoperative pure-tone average air-bone gaps was 16 dB in
partial ossicular replacement prosthesis groups combined. The mean air– partial reconstructions and 26.7 dB in total reconstructions (P < 05). There
bone gap improved from 30.38 ± 11.12 dB pre-operatively to 15.62 ± 9.65 were five cases of prosthesis extrusion.
dB post-operatively, for both groups combined.
Conclusions: The majority of the ossiculoplasties improved the hearing sta-
Conclusion: Reconstruction with a titanium prosthesis offers good func- tus satisfactorily. There was no difference in hearing results in one-stage and
tional results when performed during canal wall down surgery for ad- two-stage partial ossicular chain reconstruction, but there were better hearing
vanced cholesteatoma as a single-stage procedere. results in the cases of two-stage total Ossicular chain reconstruction.

®
Preliminary ossiculoplasty results using the Kurz titanium Hearing results with the titanium ossicular
middle ear implants replacement prostheses
Heylbroeck Ph., De Vel E., Dhooge I. Schmerber S., Troussier J., Dumas G., Lavieille J.-P., Nguyen D. Q.

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