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Coupling problems in middle ear reconstruction Conclusion: This study demonstrates that the results remain stable over
the long term and in contrast to other methods of chain reconstruction the
Zahnert T. sound conduction component is reliably reduced. This was also the first
time that a validated measurement procedure could be used to show that the
Published: MEMRO 2006, 4th International Symposium on Middle Ear subjective quality of life of patients is positively affected over the long term.
Mechanics in Research and Otology: Selected Abstracts. Reconstruction of the ossicle chain with Titanium-CliP® Prostheses is now
an established procedure.
The normal and reconstructed middle ear can be considered as a mechani-
cal vibrating system. After the implementation of tympanoplasty as a stan-
dardized surgical technique various reconstruction techniques and implants Titanium CliP Prosthesis
were suggested for the reconstruction of the tympanic membrane and the
ossicular chain. Laser–Doppler-vibrometry and model calculations have Hüttenbrink K.-B., Zahnert T., Wüstenberg E.G., Hofmann G.
given new insight into the vibration modes of the normal and reconstruct-
ed middle ear during the recent years. Nowadays it can be concluded, that Published: Otology & Neurotology 25:436-42 (2004)
not only material properties of implants but also coupling factors have an
important influence on good hearing results. We investigated coupling fac- Objective: Prostheses for the reconstruction of a defective ossicular chain
tors between tympanic membrane and the surrounding bone, between the should be stable and firmly anchored to the ossicular remnants. This will
tympanic membrane and middle ear implants and between the prosthesis prevent a defective connection from causing diminished sound transmission
and the ossicular chain using model calculations and temporal bone exper- efficiency and will keep the prosthesis from tilting or even losing contact,
iments. The quality of the tympanic membrane, which can be considered which would result in a sound transmission block. Through temporal bone
as the “motor of the middle ear”, has the most important impact on the experimentation, we have consequently developed a very lightweight titani-
sound transfer to the inner ear. Ventilation and mucosa problems can damp um prosthesis, which is fastened onto the stapes head with a clip mechanism.
the tympanic membrane vibrations as well as the reconstruction techniques
or the mechanical properties of transplants. The coupling of the tympanic Methods: When temporal bone experiments using laser Doppler vibrometry
membrane to either the surrounding bone or the cartilage transplants has confirmed that the prosthesis functioned well acoustically and when luxation
an influence on the stiffness. The contact of the tympanic membrane to the experiments proved that it could be safely used without the risk of stapes
malleus handle is of importance in order to allow good sound conduction dislocation, the prosthesis was used in a clinical application within an obser-
to middle ear prostheses in the high frequency range. Furthermore the con- vational study. The University of Dresden Otorhinolaryngological Hospital
tact of prostheses to the stapes head or the footplate may influence hearing as well as seven surgeons from five other hospitals participated in the study.
results. In our investigations the angle of prostheses towards the tympanic
membrane and the stiffness of coupling plays an important role. Concerning Results: The results of 133 operations showed that, in over 90% of the
the angle it is of importance to distinguish between the x and y – direction. cases, the prosthesis could be implemented without problems and with good
An absolutely stiff contact between malleus and stapes can reduce the sound mechanical stability. The first acoustical results obtained during the first
transfer and increase the risk of prosthesis dislocation or even damage of year from 49 patients showed a sound transmission improvement range
the annular ligament. Even nowadays modern middle ear reconstructions from 12 dB to 14 dB.
can only simulate the simple function of a columella. In future it may be
important to invent middle ear implants which will be able to fulfil both Conclusion: With the clip prosthesis, it seems possible to further improve
required middle ear functions – the sound transfer and the compensation of defective middle ear function, which would allow the patient to regain so-
atmospheric pressure changes. It can be assumed that hearing results may cial hearing after middle ear reconstruction. The reliability of the fasten-
improve due to an unstressed coupling of middle ear prostheses by taking ing is an innovation. Revision operations showed a stable prosthesis-stapes
the above mentioned techniques and findings into consideration. complex in the middle of a recurring cholesteatoma and the prosthesis could
always be easily pulled from the stapedial suprastructure.
Long-term hearing results and patient satisfaction after
tympanoplasty with Titanium-CliP Prostheses
Wolferts G., Schicke D., Delank K.W. ANGUL AR CLIP PROS THESIS
Published: 86th Annual Meeting of the German Society for Oto-, Rhino-,
Laryngology, Head and Neck Surgery. Berlin, May 13-16, 2015. Düssel- Titanium Angular Clip: A New Prosthesis for
dorf: German Medical Science GMS Publishing House; 2015. Doc15h- Reconstruction of the Long Process of the Incus
nod526, March 26, 2015. Poster Abstract (German)
DOI: 10.3205/15hnod526 Hüttenbrink K.-B., Luers J.C., Beutner D.
Introduction: Titanium-CliP® Prostheses (Dresden or FlexiBal® type, Kurz) Published: Otology & Neurotology 30(8):1186-1190, December 2009
have been in use for reconstruction of the ossicle chain for several years. So DOI: 10.1097/MAO.0b013e3181b287f2
far only a few studies of the long-term audiological and otological results
have been published. The quality of life of patients has not been analyzed. Objective: To describe a new titanium angular clip prosthesis for bridging
the incudostapedial joint in the event of an isolated lesion of the distal end
Methods: From 2003-2013 140 patients received a tympanoplasty with im- of the long process of the incus.
plantation of a Titanium-CliP® Prosthesis in this hospital. We conducted a
retrospective, monocentric study with prospective follow-up of up to eleven Study Design: Clinical retrospective study.
years after the initial procedure. Otological microscope findings and audio-
logical measurement data were evaluated for the analysis. The quality of life Methods: We retrospectively reviewed the course of 22 patients with iso-
was evaluated based on the Glasgow Benefit Inventory. The objective of the lated defects of the long process of the incus where the ossicular chain was
study was to find information on the long-term hearing results (air-bone gap reconstructed by a titanium angular clip prosthesis.
before and after operation), the seating of the prosthesis, the rate of revision
operations, protrusions and extrusions, and patient satisfaction. Results: The placement of the prosthesis was successful in all patients,
and no complication was encountered during its installation. At the first
Results: 30 patients were recruited and the average follow-up was 64 months. follow-up visit after 3 weeks, the mean air-bone gap (ABG) was reduced
The validated analysis of quality of life showed an improvement; protru- by around 10 dB from a mean of 26 dB preoperatively to 16 dB postop-
sions or extrusions were documented in isolated cases. The sound trans- eratively. The mean postoperative hearing result of patients with a Type A
mission component - measured over frequencies 0.5-4 kHz - was reduced tympanogram (7-dB ABG) was consistently better than for patients with a
pantonally from an average of 21 dB to 10.2 dB. Type B or a Type C tympanogram (19-dB ABG in both).

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