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grafts at 48 weeks postoperatively (a success rate of 90 %) showing full and patients follow up. All patients included in the study had a minimum
union and epithelialization of palisades, and with three patients displaying follow up of 6 months.
small defects. The mean pure tone air bone gap pre- and postoperatively
was 32.4 and 8.8 dB, respectively, with most patients reporting satisfactory The aim of the study was to analyse the audiological results of different
postoperative hearing. No evidence of implant extrusion was found in the grafting materials, which werecombined with ossicular chain reconstruc-
48-week period. Tympanic membrane reconstruction using full thickness tion. In general, the audiological results achieved in ears which needed a
palisades of tragal cartilage provides good functional and hearing outcomes tympanoplasty type I or III showed postoperatively for 80 % of the patients
in type 3 tympanoplasty with titanium prostheses. an improved hearing compared to preoperatively. The best hearing results
were achieved in those ears in which primary tympanoplasty type I was per-
formed without ossicular chain reconstruction (type I tympanoplasty). The
A micro-computed tomographic study: determination of the grafting materials we used (perichondrium, cartilage palisades, perichondri-
angle between the tympanic membrane and stapes footplate umcartilage composit graft (PCCG)) showed 6 months postoperative a sim-
in a total ossicular reconstruction prosthesis reconstruction ilar air bone gap. The audiograms were measured for the frequencies from
0.5 kHz to 8 kHz. Hearing results were best at 2 kHz. As expected, those
Herkenhoff S., Fischer B., Gleich O., Strutz J., Kwok P. patiens who requiered type III TORP tympanoplasty enjoyed less hearing
recovery than those who required a type I tympanoplasty or a PORP.
Published: Otol Neurotol. 2011 June; 32(4): 610-5
DOI: 10.1097/MAO.0b013e318213af4d Perichondrium and the cartilage techniques led to simular results. It should
not be unmentioned that repreferations occured. The perforation closure
Objectives: To examine the anatomical relationship of the angles between rate in type III tympanoplasties was 92.3%, the total repreferation rate was
tympanic membrane and stapes footplate and the variation of these angles 7.7 %. Based on temporal bone studies using a laser doppler vibrometer also
among different temporal bones in order to characterize the optimal shape the influence and the audiological quality of different middle ear protheses is
of total ossicular reconstruction prostheses (TORPs). discussed. The results of the temporal bone study as well as the initial clinical
findings using a new light titanium (n=396) prostheses are discussed. Not
Methods: Ten specimens of human temporal bones were prepared for surprisingly the combination or different graft materials and different proth-
examination with micro-computed tomography. Five of the 10 temporal eses led to similar clinical results except in type III TORP tympanoplasty.
bones were implanted with 3 types of TORPs before subjecting them to In these type of tympanoplasty with a reconstruction of the ossicular chain
micro-computed tomography. The angles between tympanic membrane and between stapes footplate and reconstructed eardrum significant better results
stapes footplate were determined. The contact of the TORPs to these struc- were obtained when using cartilage. Based on our data we can conclude that
tures was assessed. tympanoplasty nowadays is able to improve the hearing.
Results: The angle between the stapes footplate and the tympanic mem-
brane was, on average, 25.9 degrees in a plane along the transverse axis of
the stapes footplate and 24.6 degrees in a plane along the longitudinal axis TITANIUM AND O THER MATERIALS
of the stapes footplate. Consideration of these angles in TORPs resulted in
an optimal contact with the tympanic membrane and stapes footplate, espe-
cially for prostheses with a large foot. Biocompatibility of nitinol stapes prosthesis
Conclusion: TORPs should be adjusted in shape before insertion into the mid- Roosli C., Schmid P., Huber A.M.
dle ear. Further developments should consider prostheses with preadjusted an-
gles or appliances for the exact modification of the prostheses during surgery. Published: Otol Neurotol. 2011 Feb;32(2):265-70.
DOI: 10.1097/MAO.0b013e318201622e.
Germany Tympanoplasty today - an analysysis of 11000 cases Objective: Use of the SMart piston, a nitinol-based, self-crimping prosthe-
of reconstructive middle ear surgery - the Würzburg experience sis in stapes surgery may allow improved functional results because of bet-
ter sound transmission properties at the incus-prosthesis interface because
Müller J., Schön F., Brill S., Helms J., Hagen R. of the elimination of manual crimping. Possible disadvantages include ther-
mal damage or strangulation of the incus and its mucoperiosteum or nickel
Published: MEMRO 2006, 4th International Symposium on Middle Ear intolerance. The goal of this study was to morphologically assess the fixa-
Mechanics in Research and Otology: Selected Abstracts. tion of this prosthesis to the incus, investigate the reaction of the middle ear
mucosa to the prosthesis, identify alterations to the incudal bone, and detect
Nowadays middle ear surgery is not only done to treat mastoiditis and to deposits of nickel in the tissue around the prosthesis.
prevent its complications, which are highly dangerous. Middle ear surgery
is also done to restore the hearing. Ojala summed up the situation in the sev- Study Design: Prospective consecutive case analysis. Setting: Tertiary
enties when he stated that „hearing after tympanoplasty usually does not im- referral center. Patients: Four patients with an unfavorable functional
prove (and in some cases even deteriorates)“. Since Wullstein (Würzburg) result after primary SMart-piston stapedotomy. Intervention: Revision
discribed the basic principles of tympanoplasty in the early 50ties, many malleostapedotomy with explantation of the incus and prosthesis for further
other otologists made additional contributions to our current knowledge of analysis.
tympanoplasty. The aims of tympanoplasty have been and still are:
Main Outcome Measures: Analysis of intraoperative findings and post-
• the elimination of the pathological changes operative examination of the explants using light- and scanning-electron
• to create stable conditions and easy access for postoperative care microscopy, energy dispersive x-ray analysis, and atom absorption spec-
• to reconstruct the sound conduction mechanism. trometry.
Numerous grafting materials have been recommended for the closure of Results: The intraoperative, macroscopic, and scanning electron micro-
tympanic membrane perforations. This paper evaluates three different graft- scopic investigation showed tight circular fixation of the prostheses, where-
ing materials for the reconstruction of the tympanic membrane: as a gap between the prosthesis and the lateral incus was found in 1 case. All
• Pericondrium prostheses were overgrown by mucosa. Superficial localized erosion of the
• Cartilage incudal bone was found in 2 cases. There was no elevation in nickel content
• Perichondrium-Cartilage Composite Graft in the removed tissue samples.
The study is based on a computerized documentation system called „Würz- Conclusion: The lateral gap between prosthesis and incus did not affect
burger Ohrbogen“. This system includes now more than 11000 patient’s fixation of the prosthesis, neither did covering by a mucosal layer. Bone ero-
records. The database comprises information on surgical details (324 items) sion was most likely caused by laser in one and by the prosthesis in another

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