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of a Finite Element Model (FEM) these data were used for optimizing the fitted and 21 patients with a Soft CliP Piston (both from Kurz Medizintech-
clip shape. Design criteria were a minimal variation of the contact force nik, Dusslingen, Germany). Air and bone conduction were tested preoper-
for different cross-sections and to minimize the force necessary to slide the atively and 5 to 6 weeks after surgery in all patients, as well as after about
clip over the incudal process. The new clip has a lower stiffness and can 1 year in a subgroup.
therefore be applied onto different incus diameters. The lower contact force
reduces the risk of arrosion. Due to its optimized shape, the maximal stress Results: We found a mean air-bone gap of 8.5 +/- 5.2 dB in the frequen-
in the clip is lowered preventing plastic deformation during the application cies 0.5, 1, 2, and 3 kHz for the patients with a CliP Piston à Wengen at
procedure. The application force was decreased by up to 45% depending follow-up audiometry after an average of 31 days, and of 6.4 +/- 3.7 dB for
on the application points. This leads to easy and safe application reducing 11 patients after 412 days. The corresponding figures for patients with Soft
the risk of damaging the ossicular chain. CliP Pistons were 8.9 +/- 4.1 dB after 44 days, and 6.3 +/- 5.6 dB for 10
patients after 419 days. There were no statistically significant differences.
All the prostheses were implanted without difficulty.

CLIP PIS T ON À WENGEN Conclusions: The two stapes prostheses studied gave good early audio-
metric results that showed no difference. After a short learning period,
both could be pushed onto the long process of the incus with similar ease,
Diagnostic Findings in Stapes Revision Surgery - although subjectively the new design of the Soft CliP seemed to adapt bet-
A Retrospective of 26 Years ter to the different diameters of the process and took up less space in the
middle ear.
Schimanski G., Schimanski E., Berthold M.R.
Published: Otology & Neurotology: April 2011 - Volume 32(3): 373-383 CO2 laser-assisted stapedotomy
DOI: 10.1097/MAO.0b013e3182096da1 combined with à Wengen titanium clip stapes prosthesis:
superior short-term results
Objectives: The aim of the study is to obtain a detailed overview of the
revision findings after stapes operations and to draw conclusions on a stapes Forton G. E. J., Wuyts J., Floris L., Delsupehe K. G.,
prosthesis that can be recommended. Verfaillie J., Loncke R.
Study Design: Retrospective case series. Setting: Tertiary otologic referral Published: Otology & Neurotology: December 2009; 30(8):1071-8
center. DOI: 10.1097/MAO.0b013e3181a52ab4
Methods: Approximately 12,000 middle ear operations within a period of Objectives: To report on the short-term results of CO2-laser assisted stape-
26 years were evaluated. The findings of the revisions were classified into dotomy combined with the à Wengen titanium clip stapes prosthesis. A
surgeon related, prosthesis related, and other causes. comparison with published series using other prostheses and/or different
stapedotomy techniques is made.
Results: Three hundred forty-three stapes revisions were done. Many differ-
ent prostheses were found: the most common were Schuknecht prostheses Study Design: Retrospective case series.
and Teflon platinum, gold, and titanium pistons. Polyethylene strut, Teflon
wire pistons, Shea (Teflon) pistons, and other techniques, such as columel- Patients: Patients with a history and audiologic data matching stapes fix-
la or malleovestibulopexy, were rarely found. There are specific findings ation and computed tomographic imaging excluding other anomalies such
correlating to certain prostheses: Schuknecht prostheses were too short in as malleus fixation, dehiscent superior semicircular canal, and large vestib-
50% of the revisions (surgeon related), Teflon platinum caused necrosis or ular aqueduct that may mimic stapes fixation-like hearing loss.
arrosion of the long incudal process (prostheses related) in 69%, and gold
caused reparative granuloma sometimes combined with necosis of the incus Intervention: All patients underwent CO2 laser-assisted stapedotomy
in 70% (prostheses related). There was no specific diagnostic finding with (Lumenis Co. Israel CO2 laser, Acuspot 712, SurgiTouch 870 scanner) and
titanium pistons, neither surgeon nor material related. subsequent reconstruction by means of the àWengen titanium clip stapes
prosthesis by Heinz Kurz Medizintechnik GmbH (Germany).
Conclusion: An analysis of revision findings over an extended observation
period can enable middle-ear surgeons to improve their surgical techniques Outcome Measures: Comparison and statistical analysis of preoperative
and to select the best suited prosthesis. Self-fabricated stapes prostheses and postoperative audiologic data.
(e.g., Schuknecht) do not conform to required quality standards and should
not be used. GoPi, which is no longer available, and TPlPi showed prosthe- Results: Sixty-two stapedotomies were performed (61 patients) using the
sis-related diagnostic findings. The titanium prostheses used by the authors CO2 laser and àWengen titanium clip stapes prosthesis. The mean postop-
have proven to be excellently compatible and can therefore be recommend- erative air-bone gap 3 months postoperatively was 5.1 ± 0.5 dB (standard
ed as safe stapes prostheses. deviation [SD], 4.1 dB; 0.5, 1, 2, 4 kHz). Air-bone gap closure less than or
equal to 10 dB was achieved in 54 cases (87%). Air-bone gap closure less
than 20 dB was achieved in all cases. The average gain was 27.8 ± 1.5 dB
First Experience With a New Titanium (SD, 12 dB; 0.5, 1, 2, 4 kHz). The average bone-conduction threshold shift
Clip Stapes Prosthesis and a Comparison With the Earlier or “overclosure” on 2,000 Hz was 13.6 ± 1.3 dB (SD, 10 dB). There was
Model Used in Stapes Surgery no postoperative perceptive hearing loss exceeding 15 dB on any measured
frequency. The Amsterdam Hearing Evaluation Plots have also been used
Hornung J. A., Brase C., Bozzato A., Zenk J., Iro H. to evaluate our data. These data were statistically analyzed and compare
favorably to other published series.
Published: Laryngoscope, 2009 Dec;119(12):2421-7
DOI: 10.1002/lary.20641 Conclusion: The authors conclude that the combination of CO2 laser-as-
sisted stapedotomy and the àWengen titanium clip stapes prosthesis is a
Objectives/Hypothesis: The aim of the study was to gain the first clini- combination likely to yield superior results in experienced hands.
cal experience with a new titanium clip prosthesis in stapes surgery, and to
compare this model with its predecessor. We placed particular emphasis on
the practicability of fixing the prosthesis to the long process of the incus Development of a new CliP-Piston prosthesis for the Stapes.
and on the postoperative improvement in hearing. Study Design: Retro- Middle Ear Mechanics in Research and Otology
spective chart review.
Schimanski G., Steinhardt U., Eiber A.
Methods: The study included 23 patients who had a CliP Piston à Wengen

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