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Published: 24th Politzer Society Meeting 31 August – 4 September 2003, ation. The present report offers a treatment plan for a group of patients requir-
Amsterdam, the Netherlands: Selected Abstracts ing reconstruction of the entire ossicular conduction mechanism including
removal of the stapes footplate. Study Design: Retrospective review.
In the majority of chronic middle ear disease, there is an ossicular chain
defect. Various types of prostheses are used for ossiculoplasties. The most Methods: Three thousand three hundred fifty (3350) charts of patients
common are autogenous or allogenous bone or cartilage, plastipore. hy- requiring total ossicular replacement prostheses (TORPs) were reviewed. Of
droxyapatite, bioactive glass and many other prostheses. Since a few years this group of patients, only 21 of 3350 patients from 1977 to 1999 required
different metals were also available, like gold and titanium. Between No- TORP placement and removal of the stapes footplate. The patients were
vember 1997 and January 2003, 77 patients were operated for chronic ear followed for an average period of 50 months.
disease. Two types of titanium ossicular prostheses were used for ossicu-
loplasties (40 Spiggel and Theis® and 37 Kurz®). We performed interpo- Results: Hearing results indicated an overall improvement in the air-bone
sitions of the tragal or allograft cartilage. The mean age was 41 years old gap of 10 dB, with 52% achieving an air-bone gap of less than 20 dB.
and the average follow- up was 31 months for the Spiggel and Theis® and Of the 21 cases, 5 revision surgeries were performed. Three were performed
5 months for the Kurz®. We used 43 total ossicular prostheses (TORP) and because of a displaced TORP (14.2%). and 2 were performed because of
34 partial (PORP). One patient had a prosthesis extrusion after a postop- extruded TORPs (9.5%).
erative infection. All others had stable anatomical results. The pure tone
average air-bone gap (PTA-ABG) was calculated on 500,1000, 2000 and Conclusions: Reconstruction of the entire ossicular conduction mechanism
4000 Hz in preoperative and at the last postoperative consultation. For including removal of the stapes footplate can be successfully achieved with
the TORPs, the PTA-ABG ≤ 20 db was found in 55% of the cases for the improvement of the air-bone gap of less than 20 dB. Hearing results and
Spiggel and Theis® and 63% for the Kurz®. For the PORPs it was 54% extrusion rates are comparable to reported results of TORP placement on a
for the Spiggel and Theis® and 71 for the Kurz®. mobile footplate. Successful stapedectomy and simultaneous ossicular chain
reconstruction can be performed as a single or staged procedure. Special
Titanium ossicular prostheses offer advantages compared to other prosthe- attention is paid to avoid intrusion of the prosthesis into the vestibule.
ses having a very easy and simple surgical manipulation, excellent anatom-
ical stability and good functional results The Kurz® prostheses procured us
better functional results because of the sizer prostheses set which permits a Revision Ossicular Reconstruction with the
better evaluation of the height and the right position of the prosthesis. Titanium Kurz Prosthesis
Downs B. W., Pearson J. M., Zdanski C. J.,
Early Results With Titanium Ossicular Implants Buchman C. A., Pillsbury H. C.
Ho S. Y., Battista R. A., Wiet R. J. Published: Laryngoscope 112: August 2002
DOI: 10.1097/00005537-200208000-00002
Pubished: Otology & Neurotology, March 2003; 24(2): 149 - 152
Objectives/Hypothesis: One European multicenter study has reported
Objective: To report the efficacy of titanium middle ear prosthesis for os- favorable outcomes after ossicular reconstruction with the titanium Kurz
sicular reconstruction. Study Design: Retrospective chart reviews were per- prosthesis. At the time of this study, however, no study has analyzed its
formed for 25 patients who had undergone titanium ossicular implants be- outcomes when used for reconstruction after prior failure with another
tween January 1, 1999, and June 1, 2001. Setting: Tertiary otology referral implant (revision reconstruction). The study reports our experience with
center. Patients: All patients had a minimum of 6 months of postoperative the titanium Kurz prosthesis for revision ossicular reconstruction. Study
follow-up and no evidence of recurrent otologic disease. Intervention: All Design: A retrospective review was made of all revision ossicular recon-
patients had undergone ossiculoplasty using titanium middle ear implants. structions at our institution from October 1998 to September 2001.
Main Outcome Measures: Comparisons of preoperative and postoperative Methods: Seventeen cases were reviewed. Patients were divided into two
pure tone averages were performed. Air-bone gap closures and implant ex- groups: patients who underwent revision ossicular reconstruction with the Kurz
trusion rates were measured. prosthesis and patients who underwent revision ossicular reconstruction with an-
other prosthesis (the "other" group). Audiograms were reviewed and air-bone
Results: Overall mean pure tone averages improved 22.2 dB with air-bone gaps were calculated for each patient.
gap improvement at 20.9 dB. Fifty-six percent of patients achieved air-bone
gap less than 20 dB postoperatively. The overall extrusion rate was 4%. Results: The average postoperative air-bone gap after Kurz revision was
However, with the placement of cartilage graft interposed between the pros- 15.6 dB, a statistically significant improvement over the average postoperative
thesis and the tympanic membrane, no extrusion was observed. air-bone gap from the "other" revision group (P =.022).

Conclusion: Titanium implants provide comparable hearing improvement Conclusions: The titanium Kurz prosthesis has been an effective implant at
compared with other materials. The extrusion rate seems quite low if cartilage our institution for revision ossicular reconstruction. Future research should
interposition graft is inserted. Its ease of handling, biocompatible properties, focus on a prospective, randomized trial comparing the Kurz prosthesis with
and sound conducting properties improve its efficacy as an ossicular implant. other prostheses currently in use.

Reconstruction of the entire ossicular conduction mechanism Titanium as a material for ossicular replacement –
basic aspects and clinical application
Battaglia A., McGrew B. M., Jackson C. G.
Schwager K.
Published: Laryngoscope, 113:654-658: April 2003
DOI: 10.1097/00005537-200304000-00013 Published: Laryngorhinootologie 2002 Mar; 81 (3):178-83. (German)
DOI: 10.1055/s-2002-25037
Objectives/Hypothesis: Stapes fixation combined with fixation, absence, or
malformation of the malleus-incus complex requires an uncommon surgical Background: The use of titanium as a biomaterial in ossicular chain recon-
reconstruction and offers a unique combination of challenges and hazards. struction is increasing. The situation for integration of biomaterials is more
This situation may occur in the presence of severe tympanosclerosis, oto- difficult in the semiopen implantation site middle ear than in other parts of the
sclerosis, congenital ossicular malformations, and revision surgery for either body. Important for integration is the contact of the biomaterial's surface to-
stapedectomy or chronic ear disease. In previous reports, this procedure has ward proteins. Studies of the integration in living tissue still have to be performed
been grouped with total ossicular reconstruction without much distinction. in animal experiments. Morphological examinations of explanted prostheses af-
However, the challenges unique to this problem deserve special consider- ter clinical use complete the picture of an ossicular replacement material.

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