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Bance M., Morris D.P. Vanwijhe R.G., compared with rigid TORP. In average, it provides an equivalent sound
Kiefte M., Funnell W.R. transfer like the intact middle ear. At positive pressure, the flexible TORP
performs slightly worse. Both performed worse than the intact middle ear,
Published: Otol Neurotol. 2004 Nov;25(6):903-9. which is related to an uplifting of the prostheses.

Hypothesis: Ossiculoplasty using prosthetic reconstruction with a malleus Conclusion: The findings may be considered preliminary as this experi-
assembly to the stapes head will result in better transmission of vibrations mental study was limited to just one of the many different possible situa-
from the eardrum to the stapes footplate than reconstruction with a tympan- tions of tympanoplasty and it involved a small sample size. Nevertheless,
ic membrane assembly to the stapes head. Both types of reconstruction will the results with the flexible TORP were promising and could encourage
be affected by tension of the prosthesis. further investigations on such prostheses.

Background: Theories (and some clinical studies) that the shape of the nor-
mal tympanic membrane is important suggest that prosthetic reconstruction Comparison of the functional results of partial and total
to the malleus performs better than reconstruction to the tympanic mem- prostheses with chronic otitis media
brane. This has not been previously tested by directly measuring vibration
responses in the human ear. Our previous work suggests that tympanic Dombrowski T., Minovi A., Dazert S.
membrane assembly to the stapes head type prostheses performed best un-
der low tension. This had not been previously tested for malleus assembly Published: 86th Annual Meeting of the German Society for Oto- Rhi-
to the stapes head type prostheses. no- Laryngology, Head and Neck Surgery e.V. Berlin, May 13-16, 2015.
Meeting Abstract (German). DOI: 10.3205/15hnod328
Methods: Hydroxyapatite prostheses were used to reconstruct a missing
incus defect in a fresh cadaveric human ear model. Two types of prostheses Surgical treatment of chronic otitis media often requires not only reliable
were used, one from the stapes head to the malleus (malleus assembly to reconstruction of the tympanic membrane but also restoration of the ossi-
the stapes head), the other from the stapes head to the tympanic membrane cle chain for sound transmission. The combination of autologous cartilage
(tympanic membrane assembly to the stapes head). Stapes footplate center with a partial (PORP) or total prosthesis (TORP) of titanium is one of the
responses were measured using a laser Doppler vibrometer in response to most common surgical methods. The objective of the study was a differen-
calibrated acoustic frequency sweeps. tial comparison of both types of prosthesis with reference to the functional
results. We evaluated the results of 199 patients who were operated on in
Results: Tension had a very significant effect on both types of prostheses in our hospital for chronic epitympanal or mesotympanal otitis media from
the lower frequencies. Loose tension was best overall. The malleus assem- 2006 to 2013 in a retrospective, exploratory data analysis.
bly to the stapes head type prostheses consistently performed better than
the tympanic membrane assembly to the stapes head type prostheses when The TORP group experienced significantly poorer preoperative and post-
stratified for tension. operative conductive hearing loss (CHL) but higher average postoperative
reduction of the CHL. The best hearing improvement for the PORP group
Conclusion: Tension has a significant effect on prosthesis function. Mal- was at 0.5kHz (7.93dB average reduction of CHL), and the worst at 4kHz
leus assembly to the stapes head type prostheses generally result in better (4.06dB). After TORP implantation there was an average reduction of the
transmission of vibrations to the stapes footplate than tympanic membrane CHL at frequencies between 8.37dB (3kHz) and 10.53dB (4kHz).
assembly to the stapes head type prostheses.
The functional result of the PORP showed no connection to the postop-
erative observation period. At TORP implantation the CHL improved,
significantly in some cases, after more than 6 months. A regular and sig-
T O TAL AND PARTIAL RECONS TRUC TION nificant hearing improvement can be achieved with both prostheses. In the
low-frequency range the PORP achieved a significant hearing improve-
ment, while the TORP appeared to have advantages above 25dB particu-
Function, Applicability, and Properties of a Novel larly with revision operations and preoperative CHL. The hearing result
Flexible Total Ossicular Replacement Prosthesis With a with PORP prostheses with increased follow-up time showed no change,
Silicone Coated Ball and Socket Joint while after TORP implantation hearing results were improved in all
frequencies after more than 6 months.
Stoppe T., Bornitz M., Lasurashvili N., Sauer K.,
Zahnert T., Zaoui K., Beleites T.
Cartilage Palisades in Type 3 Tympanoplasty:
Published: Otol Neurotol. 2018 Jul;39(6):739-747. Functional and Hearing Results
DOI: 10.1097/MAO.0000000000001797
Vashishth A., Mathur N. N., Verma D.
Hypothesis: A total ossicular replacement prosthesis (TORP) with a sil-
icone coated ball and socket joint (BSJ) is able to compensate pressure Published: Indian J Otolaryngol 09/2014, Volume 66, Issue 3, pp 309 - 313.
changes and therefore provide better sound transmission compared with DOI: 10.1007/s12070-014-0717-3
rigid prostheses.
To evaluate the functional and hearing outcomes using full thickness broad
Background: Dislocation and extrusion are known complications after cartilage palisades for tympanic membrane reconstruction in type 3 tympa-
TORP reconstruction, leading to revisions and recurrent hearing loss. Poor noplasty with titanium prostheses. The retrospective study performed at a
aeration of the middle ear, scar tension, and static pressure variations in tertiary referral institute included 30 patients with posterior mesotympanic
conjunction with rigid prosthesis design causes high tension at the implant retraction pockets or tympanic membrane perforations requiring tympanic
coupling points. membrane and type 3 ossicular reconstruction. Patients with disease extend-
ing beyond the aditus requiring canal wall down mastoidectomy were ex-
Methods: A novel TORP prototype with a silicone coated BSJ has been cluded. Disease removal from posterior mesotympanic and epitympanic re-
developed. Experimental measurements were performed on nine fresh ca- cesses was confirmed using angled endoscopy and ossicular reconstruction
daveric human temporal bones of which five were used for a comparison was performed using titanium partial or total ossicular replacement pros-
between rigid TORP and flexible TORP tympanoplasty. The middle ear theses. Tympanic membrane reconstruction was done, with or without attic
transfer function was measured at ambient pressure and at 2.5 kPa, both reconstruction, using full thickness broad cartilage palisades harvested from
positive and negative pressure, applied in the ear canal. the tragus with perichondrium attached laterally. Patients were assessed at
24 and 48 weeks for graft status and any evidence of implant extrusion.
Results: The flexible TORP design yields a better transmission of sound Hearing evaluation was done using subjective assessment and pure tone
after implantation and at negative pressure inside the tympanic cavity, audiometry. In total, 27 out of 30 patients had intact and completely healed

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