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the results of routine use over a three year period. designed to sit under the tympanic membrane. Previously, the author had
designed titanium prostheses with a malleus notch extension at the head
Methods: From November 1994 to November 1997, 661 titanium implants plate. The present study aimed to assess whether these customised prosthe-
(Dusseldorf model) were implanted in the authors’ clinics (355 PORP, 306 ses were user-friendly, compared with conventional prostheses. Fourteen
TORP). There was no preselection of patients. Five hundred eighty-two follow surgeons were recruited to examine the user-friendliness of several ossicu-
up examinations were performed with a medium follow up time of 11.6 months. lar prostheses. They performed ossiculoplasties on temporal bones and rat-
ed the user-friendliness of the malleus notch prosthesis against that of some
Results: The good initial results of the previous study with respect to bio- of the more popular conventional ossicular prostheses. For malleus-stapes
compatibility and functional hearing results were confirmed in the long assembly, eight out of 13 surgeons preferred the malleus notch prosthesis
term follow-up. The average air-bone gap was calculated over the frequen- to the Düsseldorf and Goldenberg designs. For malleus-footplate assembly,
cies 0.5, 1, 2, and 4 kHz. Closure to within 20 dB was achieved in 72% six out of 10 surgeons preferred the malleus notch prosthesis to the Düssel-
of cases. The air-bone gap tended to decrease with increasing time of im- dorf and Richards designs. Most of the surgeons stated that the reconstruc-
plantation. Adverse reaction to the prostheses did not occur. Extrusion oc- tion was more stable using the malleus notch prosthesis.
curred 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 sta- OMEG A CONNEC T OR
bility 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 Results of chain reconstruction with missing stapes
patients (0.5%). superstructure using a jointed coupling module
(Omega connector) with titanium total prostheses
Conclusion: The superior acoustic properties of the delicate yet rigid low-
weight titanium implants combined with excellent biocompatibility lead to Fischer M.
a good hearing result if a meticulous surgical technique is employed. The
easy handling makes it a pleasure to work with these protheses. Published: German Society for Oto-, Rhino-, Laryngology, Head and Neck
Surgery. 86th Annual Meeting of the German Society for Oto-, Rhino-, Lar-
yngology, Head and Neck Surgery e.V. Berlin, May 13-16, 2015. Düssel-
dorf: German Medical Science GMS Publishing House; 2015. March 26,
MNP MALLEUS NO T CH PROS THESIS 2015. Poster Abstract (German) DOI: 10.3205/15hnod336
Introduction: The Omega connector, a jointed coupling module for chain
reconstruction with missing stapes superstructure, has been available for
An Optimal Partial Ossicular Prosthesis Should Connect some years. The literature contains only two studies reporting the results of
Both to the Tympanic Membrane and Malleus: the implantation with 14 and 17 patients.
A Temporal Bone Study Using Laser Doppler Vibrometry
Methods: Retrospective evaluation of audiological results with 56 consec-
Niklasson A., Gladiné K., Rönnblom A., von Unge M., utive operations conducted by the author using the Omega connector. The
Dirckx, J., Tano K. Omega connector has always been placed where it could be securely posi-
tioned on the footplate when used with chain reconstruction in the presence
Published: Otology & Neurotology: 03/ 2018 - vol 39 - Issue 3 - p 333–339 of a defect of the stapes superstructure.
DOI: 10.1097/MAO.0000000000001699
Results: 56 operations using the Omega connector have been registered
Objective: To compare stapes vibrations in different partial ossicular since 2009. The data of preoperative and postoperative audiograms for 48
replacement prosthesis (PORP) applications. patients were available for analysis. They covered mostly male patients
(68%) and left ears (62%). The preoperative conductive hearing loss (air-
Methods: Stapedial vibrations were measured on fresh frozen human tem- bone-gap, average of distances between air and bone conduction threshold
poral bones with laser Doppler vibrometry. Eight different types of common at 500 Hz, 1kHz, 2 kHz and 3 kHz) was on average (SD) 35.36 dB (13.24),
ossiculoplasty methods were compared regarding recovery of stapes vibra- after the operation the residual conductive hearing loss was on average
tions in relation with the normal ossicular chain. The PORPs were divided 24.54 dB (8.67). 41.67% of patients reach the „criterion for success“ of a
into three groups: 1) PORPs with the lateral contact only with the tympanic residual conductive hearing loss of a maximum of 20 dB. The postoperative
membrane, 2) PORPs with lateral contact only to the malleus handle, and 3) results were analyzed with reference to different influence factors.
PORPs with lateral contact with both the malleus handle and the tympanic
membrane. Conclusions: The Omega connector in combination with titanium total
prostheses shows promising results, even in the absence of stapes super-
Results: The PORPs with lateral contact only to the malleus handle per- structure. Ventilation malfunctions are often the cause of lack of success. A
formed better than the PORPs with lateral contact to the tympanic mem- two-stage procedure should be considered in the case of CWD operations
brane only at 2 kHZ, but the best recovery was found in the group with with cholesteatoma.
contact both to the malleus handle and the tympanic membrane.

Conclusion: The best sound transmission might be achieved by placing a Ossiculoplasty with Total Ossicular Replacement
PORP in contact with both the tympanic membrane and the handle of the Prosthesis and Omega connector: Early Clinical Results
malleus. and Functional Measurements
Mantei T., Chatzimichalis M., Sim J. H., Schrepfer T.,
Titanium prosthesis with malleus notch: Vorburger M., Huber A. M.
a study of its “user-friendiness”
Published: Otology & Neurotology 09/2011: 32(7):1102-7
Yung M. DOI: 10.1097/MAO.0b013e3182267e3b
Published: The Journal of Laryngology & Otology (2007), 121,938-942. Objective: Among other difficulties, achieving a stable position of a total
DOI: 10.1017/S0022215107005944 ossicular replacement prosthesis (TORP) is demanding because of a lim-
ited view on the TORP-footplate interface and individual angles between
‘‘User-friendliness’’ is an important factor in the choice of ossicular pros- the footplate and tympanic membrane. The Kurz Omega Connector aims
thesis. The current titanium prostheses have a flat, open head plate and are at a simplified insertion of the TORP. The performance of total ossicular

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