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explant. No signs of increased nickel deposits could be found on energy perior to those of nontitanium prostheses when evaluated within 6 months
dispersive x-ray analysis or atom absorption spectrometry. We conclude that after ossiculoplasty.
a nitinol stapes prosthesis is safe for treatment of stapedial fixation.
Surgical-handling properties of the titanium prosthesis
Titanium versus autograft ossiculoplasty in ossiculoplasty

Fong J. C., Michael P., Raut V. Maassen M. M., Löwenheim H., Pfister M., Herberhold S.,
Jorge J. R., Baumann I., Nüsser A., Zimmermann R.,
Published: Acta Otolaryngol. 2010 May;130(5):554-8 Brosch S., Zenner H.-P.
DOI: 10.3109/00016480903338131
Published: Ear Nose Throat J. 2005 Mar;84(3):142-4, 147-9.
Conclusion: In this comparative series, hearing results were superior with
titanium compared with autograft ossiculoplasty in the absence of a stapes Despite the wide variety of ossiculoplasty techniques that are available, suc-
superstructure. However, in the presence of a stapes superstructure, titanium cess rates are limited. Current use indicates that surgeons prefer ceramic,
ossiculoplasties gave superior results to autografts only when comparing an autograft bone, and plastic pore prostheses. During the past decade, tita-
air-bone gap of < 10 dB. nium prostheses have been used with great promise. Although their use is
not widespread, satisfaction rates are high. An earlier study of ossiculoplas-
Objective: To compare the hearing outcomes of autograft versus titanium ty showed that titanium prostheses were effective in reducing conductive
ossiculoplasty at 1 year. hearing loss. To date, the surgical-handling attributes of titanium middle ear
prostheses have not been assessed. We report the results of our survey of
Methods: Two consecutive groups of patients with chronic suppurative 32 otologic surgeons who used the open Tubingen titanium prosthesis for
otitis media with and without cholesteatoma suitable for ossiculoplasty, primary and revision ossiculoplasty during tympanoplasty in 400 patients at
either primarily or as a staged procedure, were recruited for the study. 12 academic and nonacademic otolaryngology clinics, most of them in Ger-
A total of 52 consecutive patients who underwent an autograft ossicu- many. Because the audiometric efficacy of titanium prostheses has been pre-
loplasty were compared with 51 consecutive patients who underwent a viously reported, our primary outcomes measures included ease of use with
titanium ossiculoplasty. Hearing results were statistically compared at 1 respect to the amount of time required to prepare the implants for placement
year between the two groups using the four frequency average (FFA) of and the surgeons' overall impression of the intraoperative handling charac-
0.5/1/2/4 kHz and the American Academy of Otolaryngology-Head and teristics of the implants, taking into consideration factors such as positioning,
Neck Surgery (AAO-HNS) four frequency average of 0.5/1/2/3 kHz. The length adjustment, visibility, and the stability of the coupling. Surgeons also
results were analysed statistically. compared the properties of the titanium implant with those of gold, ceramic,
and autograft implants that they had used in the past. Based on the results of
Results: A statistically significant number of titanium TORP ossiculoplas- 383 of the 400 ossiculoplasties, our survey revealed that the titanium implant
ties achieved an air-bone gap closure to within < 20 dB compared with was significantly superior to the others in all measured respects.
the autograft equivalent group (p = 0.039 FFA; p = 0.016 AAO-HNS). The
number of titanium PORP ossiculoplasties achieving an air-bone gap clo-
sure to within < 10 dB compared with the autograft equivalent group was Ossicular Reconstruction with Titanium Prosthesis
also statistically significant (p = 0.006 FFA; p = 0.002 AAO-HNS).
Martin A. D., Harner S. G.

Titanium versus Nontitanium Prostheses in Ossiculoplasty Published: Laryngoscope 114(1):61-64 January 2004
DOI: 10.1097/00005537-200401000-00010
Coffey Ch., S., Lee F.-S., Lambert P. R.
Objectives: To evaluate the results when using titanium total ossicular re-
Published: Laryngoscope 118: September 2008, 1650-1658 placement prosthesis (TORP) or partial ossicular replacement prosthesis
DOI: 10.1097/MLG.0b013e31817bd807 (PORP) in chronic ear disease.

Objectives/Hypothesis: To compare the hearing outcomes and complica- Study Design: Retrospective chart review was performed.
tions observed using either titanium or nontitanium prostheses in a 7-year
consecutive series of ossiculoplasties performed by a single surgeon. Methods: Sixty-eight ossicular procedures using a titanium TORP (n = 30)
or PORP (n = 38) were performed at a tertiary referral center between De-
Study Design: Retrospective. cember 1999 and June 2002. The ossiculoplasty was performed either alone
or in combination with other chronic ear surgery. Cartilage grafts were
Methods: A database of ossicular reconstruction surgeries was reviewed used universally. Nineteen percent were primary operations, and 6% were
for preoperative and postoperative audiometric data including air and bone planned second stages. The majority were revision procedures. Follow-up
conduction thresholds at four frequencies and speech reception thresholds. ranged from 3 months to 2.5 years.
Outcomes were evaluated at time points less than and greater than 6 months
postoperatively. Baseline demographic and surgical characteristics and Results: The prosthesis is easy to insert, well tolerated, and has a low ex-
postoperative complications were also noted. trusion rate. Average air-bone gap (ABG) improvement was 13 dB with clo-
sure of the ABG to within 20 dB in 57% of cases. Hearing results were bet-
Results: A total of 105 cases had sufficient audiometric data available ter for primary versus revision cases for PORPs versus TORPs and for intact
for analysis, including 80 performed with titanium and 25 with nontitani- canal wall (ICW) procedures versus canal wall-down (CWD) procedures.
um implants. Follow-up ranged from 1.2 to 74.2 months, with a mean of
14.9 months. Mean air-bone gap at initial follow-up was 21.7 dB in the Conclusion: Titanium is a satisfactory material for use in ossicular recon-
nontitanium group and 15.4 dB in the titanium group; this difference was struction because of its ease of insertion, tissue tolerance, and low rate of
significant (P = .01). Postoperative air-bone gap of less than 20 dB at initial extrusion. Caution is advised when selecting candidates for this procedure
follow-up was achieved in 50.0% of nontitanium cases and 77.1% of tita- during revision surgery, especially if the canal wall and stapes superstruc-
nium cases (P = .012). This difference in "success" rates persisted at longer ture are absent.
follow-up but did not achieve statistical significance. Mean speech recep-
tion thresholds at <6 months was 29.7 dB in the nontitanium group and 22.6 119. Anatomical and functional results of titanium
dB in the titanium group (P = .049). Extrusion was observed with two non- prostheses in middle ear ossiculoplasty
titanium prostheses (8.0%) and three titanium prostheses (3.8%) (P > .05).
Gerard J.M., Blaivie C., Decat M., Garin P., Gersdorff M.
Conclusions: Titanium ossicular prostheses provide hearing outcomes su-

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