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properties of the reconstructed tympanic membrane are strongly influenced footplate at the department of otorhinolaryngology, head and neck surgery
by the reconstruction technique. The choice of the surgical technique should at the University of Cologne over an 8-year period (2007–2015).
consider requirements based on mechanical stability and acoustic transfer
characteristics of the transplant. Main Outcome Measure: The use of the ‘‘sandwich cartilage shoe
technique’’ in case of a broken or unstable footplate allows a safe
occlusion of the open vestibule.
Experimental investigations of the use of cartilage in
tympanic membrane reconstruction Results: The statistical analysis revealed a significant improvement of the
pure-tone average (p = 0.011) and airbone gap (ABG) (p = 0.016) after
Zahnert T., Hüttenbrink K.-B., Mürbe D., Bornitz M. total ossicular replacement prosthesis (TORP) implantation. The hearing
was stable at 9 months of follow up.
Published: Am J Otol. 2000 May;21(3):322-8.
DOI: 10.1016/S0196-0709(00)80039-3 Conclusion: The sandwich cartilage shoe technique offers a safe and effec-
tive option as a two-stage procedure in treating patients with fractures of the
Background: Temporalis fascia, perichondrium, and cartilage are common- stapes footplate in case of chronic otitis media. In view of the possible risk of
ly used for reconstruction of the tympanic membrane in middle ear surgery. deafness going along with a destruction of an inner ear window, our results
Cartilage grafts offer the advantage of higher mechanical stability, partic- can be considered substantial as all our patients will at least be able to regain
ularly in cases of chronic tubal dysfunction, adhesive processes, or total ‘‘social hearing’’ as they all either achieved a hearing threshold is less than
defects of the tympanic membrane, in contrast to fascia and perichondrium, 30 dB or can be sufficiently supplied with a conventional hearing aid.
which presumably offer better acoustic quality.
Hypothesis: The purpose of this study was to determine the acoustic trans- Footplate Reconstruction: Preliminary Results
fer characteristics of cartilage of varying thickness and its mechanical de-
formation when exposed to fluctuations in atmospheric pressure. Rusiecka M., Bernal-Sprekelsen M.

Method: Ten pairs of cartilage specimens from the cavum conchae and the Published: Otol Neurotol 2014 Dec;35(10):1797-800
tragus were obtained from fresh human cadavers. Young's modulus was de- DOI: 10.1097/MAO.0000000000000467
termined by mechanical tension tests and statistically evaluated using the
t test. The acoustic transfer characteristics of an additional 10 specimens Introduction: A partially or fully absent or largely perforated footplate is a
were measured by a laser Doppler Interferometer after stimulation with challenging condition that may be encountered during middle ear surgery,
white noise in an external auditory canal--tympanic membrane model. Me- especially in patients with a history of chronic ear problems or with previ-
chanical stability was determined by measuring displacement of the carti- ous tympanoplasties.
lage using static pressure loads of ≤ 4 kPa.
Materials and Methods: Retrospective study on a limited number of cases
Results: Young's modulus determinations for conchal and tragal cartilage undergoing revision tympanoplasty in which a new footplate was created
were 3.4 N/mm2 and 2.8 N/mm2, respectively, but the difference was not from the cartilage, and the ossicular chain was reconstructed with a titanium
significant. Acoustic testing showed a 5-dB higher vibration amplitude in the prosthesis in 1 stage. Minimum follow-up was 24 months. Outcome mea-
midfrequency range for conchal compared with tragal cartilage, but the differ- surements included the preoperative and postoperative bone conduction to
ence was not significant. Reducing cartilage thickness led to an improvement assess the function of the inner ear, and the preoperative and postoperative
of its acoustic transfer qualities, with a thickness ≤ 500 microm resulting in threshold levels of air and bone conduction in 4 frequencies to assess the
an acceptable acoustic transfer loss compared with the tympanic membrane. possible hearing improvement.
Conclusion: Both conchal and tragal cartilage are useful for reconstruction Results: Six patients could be included. The audiologic results showed the
of the tympanic membrane from the perspective of their acoustic proper- average air conduction gain of 11 dB. We did not observe any significant de-
ties. The acoustic transfer loss of cartilage can be reduced by decreasing terioration in the bone conduction which, in some cases, even improved (av-
its thickness. A thickness of 500 microm is regarded as a good compromise erage change of +3 dB). The symptoms related to a perilymphatic fistula were
between sufficient mechanical stability and low acoustic transfer loss. resolved. The technique described herein has proven to be safe and reliable.
Conclusion: Reconstruction of the footplate with autologous cartilage and si-
multaneous type III tympanoplasty seems to be a promising solution for those
C ARTIL A GE PUNCH rare but challenging cases in which the footplate is partially of fully absent.

Long-term Follow-up Study of the Sandwich Cartilage Shoe The Sandwich Cartilage Shoe Technique for Ossicular
Technique in Cases of Insecure Stapes Footplate Reconstruction in a Case of an Unsecure Stapes Footplate
Lüers J. C., Schwarz D., Anagiotos A., Gostian A-O., Beutner Bremke M., Huettenbrink K.-B., Beutner D.
D., Hüttenbrink K.-B.
Published: Laryngoscope, 2011 Sep;121(9):1950-2.
Published: Otol Neurotol 37:e197–e202, 2016. DOI: 10.1002/lary. 21919
DOI: 10.1097/MAO.0000000000001093
This article describes a new surgical method for total ossicular reconstruc-
Objective: Analysis of the audiometric results after repair of a defective tion in case of a broken stapes fooplate. We developed the technique of
footplate with the sandwich cartilage shoe technique in a follow-up study. the “cartilage shoe sandwich”, which consist of two surgical steps. First,
the closure of the oval window is achieved by a cartilage shoe without a
Study Design: Retrospective analysis of audiometric data. Setting: Hospital. central perforation. During this surgical intervention, the prearrangement of
a secure placement of a total ossicular replacement prosthesis is provided
Patients: The cohort consisted of 12 patients, who underwent ossicular by a second cartilage with a central hole that is plugged with silicone. In a
reconstruction after sandwich cartilage shoe technique in a case of insecure staged procedure, the silicone plug is removed and the ossicular reconstruc-
stapes footplate. The mean age was 42.7 years with an equal sex distribu- tion can be performed. The audiological results of the first patients show a
tion. In every patient, cholesteatoma was the reason for surgery with 75% stable inner ear function with an air-conduction gain of 9 dB. The technique
being revision cases. described herein has proved to be safe and reliable in total ossicular recon-
struction in the event of an unsecure stapes footplate.
Intervention: Sandwich cartilage shoe technique in case of insecure stapes

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