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reporting guidelines. The second was to compare these results with previ- Reconstruction of the ossicular chain with titanium implants.
ously published results using non-titanium-based prostheses. The third was Results of a multicenter study
to examine the authors’ results for any evidence of a “learning curve.”
Begall K., Zimmermann H.
Study Design: Retrospective chart review was performed for the period
from February 2000 to August 2001 and for the period from July 2002 to Published: Laryngo-Rhino-Otol 2000, 79 (3):139-145. (German)
February 2003. DOI: 10.1055/s-2000-298
Methods: Of 313 cases, 130 consecutive cases were identified in the Background: For decades, oto-surgeons have been trying to find suitable
first period and 65 in the second time period. One hundred two patients alloplastic materials for replacing ossicles in the case of morphological and
had adequate follow-up for published guidelines. All cases were per- functional disorders in the middle ear. The focus of attention has been on
formed by the senior author (c.g.j.). Comparison data were obtained tissue tolerance and functionality.
from a previous publication involving the senior author.
Patients: A retrospective analysis of the implantation of titanium prostheses
Results: Successful rehabilitation (≤ 20 dB pure-tone average air-bone gap) is presented (Type "Duesseldorf", Heinz Kurz GmbH, Dusslingen, Germa-
of conductive hearing loss was obtained in 70% of partial ossicular chain ny) in 528 patients operated in 14 ENT hospitals. The hospitals involved
reconstructions and 44% of total ossicular chain reconstructions when tita- are ENT hospitals with different fields of specialization presenting a repre-
nium prostheses were used. Comparison data revealed successful rehabili- sentative cross-section of surgical ENT treatment. Evaluated were healing
tation in 48% and 21% of non-titanium-based partial and total reconstruc- results, hearing gain and surgical handling of the implants.
tions, respectively. Postoperative pure-tone average air-bone gaps were not
significantly different when compared with results in the period from July Results: Despite pathological middle ear conditions, the tissue-implant
2002 to February 2003. healing rate was very high. In 4.4% of the patients the implants were reject-
ed. In the case of partial ossicular reconstruction, an average hearing gain
Conclusion: Newer titanium-based ossicular reconstruction devices rep- between 10 and 20 dB was achieved. Total reconstruction of the ossicular
resent an improvement over previously used non-titanium-based prosthe- chain showed even better audiological results (15 to 20 dB on average).
ses. The authors think that this improvement is realized rapidly because no
learning curve existed in their data. Conclusion: Due to the good morphological and functional results achieved,
titanium implants have proven their worth for middle ear micro-surgery.
Their advantages are their light weight and delicate structure, facilitating
Preliminary Ossiculoplasty Results using the Kurz Titanium very good micro-surgical handling. It is advisable to place a thin layer of
Prostheses cartilage between the prosthesis headplate and the tympanic membrane. In
this manner, the number of material extrusions can be safely reduced, how-
Krueger W. W., Feghali J. G., Shelton C., Green J. D., Beatty ever, extrusions cannot completely be avoided.
C.W., Wilson D. F., Thedinger B. S., Barrs D. M., McElveen J. T.
Published: Otology & Neurotology 23: 836-839 (2002) Replacement of ear ossicles with titanium prostheses
DOI: 10.1097/00129492-200211000-00004
Stupp C. H., Stupp H. F., Grün D.
Objective: Limitations in biocompatibility and hearing improvement with
ossicular chain reconstruction prostheses are addressed with new, light- Published: Laryngorhinootologie. 1996 Jun;75(6):335-7. (German)
weight titanium prostheses designed to maximize visualization of the ca- DOI: 10.1055/s-2007-997590
pitulum and footplate regions. The effectiveness of these new prostheses is
being tested in a prospective multicenter study. Background: Titanium has been a well established implant material for
many years. New material processing techniques now permit the manufac-
Study Design: Prospective case series. Setting: Multicenter (8 sites), pri- ture of small implants for ossicular chain reconstruction.
marily tertiary private practice or academic otologic clinics.
Methods: Between November 1994 and September 1995, 100 titanium
Patients: A convenience sample of 31 patients undergoing ossiculoplasty, middle ear implants (55 PORP, 45 TORP) were used for reconstruction of
with 16 partial ossicular chain reconstructions using the Bell prosthesis and the ossicular chain. A range of five different sizes for partial and total proth-
15 total reconstructions using the Aerial prosthesis. eses suits all implantation needs. The shape of the implants can be altered by
bending. Time consuming intraoperative shaping and trimming is avoided.
Intervention: Ossiculoplasty using new Kurz titanium prostheses.
Cartilage was interposed between the tympanic membrane and the Results: At a follow-up time of three months (33 patients) and six months
prosthesis. (17 patients), no adverse reactions or extrusions occurred. Biologic fixation
between the foot of the partial prothesis and the head of the stapes was
Main Outcome Measures: Air-bone gap for pure tone average and 3,000 found eight months after implantation. A hearing result of 0-20 dB residual
and 4,000 Hz, assessed preoperatively and 3 months, 6 months, and 12 air-bone gap was achieved in 79%.
months postoperatively; percent of patients obtaining an air-bone gap of
≤ 20 dB; high-frequency average (1,000, 2,000, and 4,000 Hz) to evaluate Conclusion: Titanium middle ear implants show good bio-compatibility and
sensorineural hearing loss; and extrusion rate. are readily integrated into the ossicular chain. Although delicate in shape, they
offer excellent mechanical properties in respect to sound conduction and im-
Results: A postoperative air-bone gap of </=20 dB was obtained in 81% of plantation. Initial results show Titanium to be a perfect implant material
Bell prosthesis patients and 67% of Aerial prosthesis patients at 3 months. for middle ear prostheses, although long-term results are not yet available.
The results were stable to improved for later time intervals. High-frequen-
cy gaps were similar to the pure tone average gap. To date, there have
been no instances of extrusion, and all the surgeons found the prostheses Three years experience with titanium implants in the middle ear
easy to use and thought that the design characteristics facilitated accurate
placement. Stupp C. H., Dalchow C., Grün D., Stupp H. F., Wustrow J.
Conclusions: Initial evaluation of the Kurz titanium prostheses produced Published: Laryngorhinootologie 1999 Jun;78(6):299-303. (German)
low extrusion rates (none to date) with excellent hearing results, including DOI: 10.1055/s-2007-996875
good high-frequency conduction. Good visualization and accurate place-
ment were easy to achieve. Further studies are needed to confirm long-term Background: In continuation of our previously published report on initial
efficacy. experience with titanium implants in the middle ear [13], we now present

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