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Material and Methods: Six patients undergoing exploratory tympanoto- Objectives/Hypothetis: To review hearing results and complications for
my for congenital conductve hearing loss or failed stapes surgery and requir- the NiTiBOND next generation shape memory prosthesis and compare
ing malleovestibulopexy are included in this study. Extended tympanomeatal them with results for the current shape memory prosthesis (SMart). Study
flap was employed for exposure of middle ear and upper malleus handle. The Design: Retrospective, multicenter chart review.
prosthesis was introduced and the clip was slipped on malleus handle. Minor
adjustments were required to attain the perpendicularity of the shaft and shaft Methods: Primary laser stapedotomy was performed using either a
insertion in the vestibule. Drilling of handle with diamond burr was required NiTiBOND or a SMart prosthesis. Ninety-two ears in 79 patients were
in half the cases to better adapt the clip on malleus handle. included in the study (67.4% female), 52 with the NiTiBOND prosthesis
and 40 with the SMart prosthesis. Data collected included demograph-
Results: The mean of air-bone gap averaged over speech frequencies was ic variables, pre- and postoperative pure-tone air and bone conduction
within 20 dB in all six cases and within 10 dB in four cases. No deteriora- thresholds, speech discrimination scores, complications, and the need for
tion of bone conduction threshold was observed. revision surgery. Pure-tone average (PTA) and PTA air-bone gap (ABG)
pre- and postoperative were computed. Success was defined as a postop-
Conclusions: The hearing resuts of malleovestibulopexy using newly in- erative ABG of ≤10 dB.
troduced titanium MVP clip prosthesis have been encouraging and almost
equal results of stapes surgery. The improved results seem to be consequent Results: There were no significant differences between groups in hear-
to the unique design of the prosthesis which factors in two key variables of ing results, including improvement in ABG, change in speech discrimina-
this procedure viz anchorage of prosthesis on malleus handle and perpen- tion, change in air or bone PTA, or change in high-frequency bone PTA.
dicularity of the prosthesis shaft in relation to stapes footplate. Short-term (mean = 4.4 and 4.9 weeks, respectively) success rates for the
NiTiBOND and SMart prostheses were 84.6% and 70.0%, respectively,
with this difference closing at the most recent test (83.7% and 80.0%,
Laser doppler vibrometry data of the Clip piston MVP respectively). No revision surgery took place in either group, and there
were no differences in complications such as dizziness, tinnitus, or taste
Arnold A., Stieger CH., Häusler R. disturbance, though the NiTiBOND group tended to have a lower rate of
transient or permanent vertigo.
Published: MEMRO 2006, 4th International Symposium on Middle Ear
Mechanics in Research and Otology: Selected Abstracts Conclusions: Compared with the SMart prosthesis, the NiTiBOND pros-
thesis is a safe prosthesis that achieves at least comparable hearing results
Background: A new malleus handle prosthesis for malleo-vestibulopexy and may offer some surgical advantages.
and revision stapedotomy has been developed at our departement and
successfully used during the last five years. The piston prosthesis bears
the CliP®-mechanism to facilitate attachment to the malleus handle and How to Avoid a Learning Curve in Stapedotomy:
length and position can easily be adjusted intraoperatively with a movable A Standardized Surgical Technique
hinge.
Kwok P., Gleich O., Dalles K, Mayr E., Jacob P., Strutz J.
Objective: The study was devised to determine if the special developed
hinge of the CliP Piston MVP causes a loss of sound transfer from the mal- Published: Otology & Neurotology 2017 Aug;38(7):931-937.
leus grip to the vestibulum. DOI: 10.1097/MAO.0000000000001475

Methods: A middle ear model was set up, consisting of a vibrator normally Objective: To evaluate, whether a learning curve for beginners in stapedoto-
used in an active implantable hearing device with a metal arm in shape and my can be avoided by using a prosthesis with thermal memory-shape attach-
dimension of an actual malleus handle, where the CliP Piston MVP was at- ment in combination with a standardized laser-assisted surgical technique.
tached with the hinge bend to an angle of about 120°. The piston end of the
prosthesis dipped in a hole of a plastic container filled with water simulating Study Design: Retrospective case review. Setting: Tertiary referral center.
a piston hole in the footplate. The excitation level corresponded to more than Patients: Fifty-eight ears were operated by three experienced surgeons and
110 dB SPL for frequencies between 100 Hz – 10000 Hz. With a laser dop- compared with a group of 12 cases operated by a beginner in stapedotomy.
pler vibrometer the movements were picked up at different spots in the area Intervention: Stapedotomy. Main Outcome Measures: Difference of pure-
of the clip, the hinge and the piston. tone audiometry thresholds measured before and after surgery.
Results: The overall characteristics of the transferfunction was practi- Results: The average postoperative gain for air conduction in the frequen-
cally identical (difference < 3dB). Additionally biphasic resonance peaks cies below 2 kHz was 20 to 25 dB and decreased for the higher frequen-
(5-10 dB) were observed around 1000 Hz. cies. Using the Mann-Whitney-U test for comparing mean gain between
experienced and inexperienced surgeons showed no significant difference
Discussion: Our results show very stable transfer properties over the fre- (p = 0.281 at 4 kHz and p > 0.7 for the other frequencies). A Spearman rank
quency band. The noticed resonance peaks of 5-10 dB are very probably correlation of the postoperative gain for air- and bone-conduction thresh-
below significance level in clinical pure tone audiometry. This is in accor- olds was obtained at each test frequency for the first 12 patients consecu-
dance with our experience from clinical practice. tively treated with a thermal memory-shape attachment prosthesis by two
experienced and one inexperienced surgeon. This analysis does not support
Conclusion: The CliP Piston MVP provides good transfer characteristics the hypothesis of a "learning effect" that should be associated with an im-
from the malleus handle to the vestibulum. proved outcome for successively treated patients.
Conclusion: It is possible to avoid a learning curve in stapes surgery by ap-
plying a thermal memory-shape prosthesis in a standardized laser-assisted
NITIBOND surgical procedure.

Next generation shape memory prosthesis (NiTiBOND) Early functional results using the NiTiBOND prosthesis
®
for stapedotomy: Short-term results in stapes surgery
Green J.D. Jr, McElveen J.T. Jr. Canu G., Lauretani F., Russo F. Y., Ferrary E., Lamas G.,
Sterkers O., De Seta D., Bernardeschi D.
Published: Laryngoscope. 2017 Apr;127(4):915-920.
DOI: 10.1002/lary.26114 Published: Acta Otolaryngol. 2016 Nov 4:1-6
DOI 10.1080/00016489.2016.1247499

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