Comparison of total and partial ossicular replacement prostheses in patients with an intact stapes suprastructure

Abstract

Objectives To compare the results of ossiculoplasty with two different partial ossicular replacement prostheses (PORP) to ossiculoplasty with a total ossicular replacement prosthesis (TORP) in patients with an intact stapes suprastructure. Methods All patients required primary or revision surgery for chronic middle ear disease and ossicular reconstruction with either a PORP or a TORP, as well as a with an intact stapes suprastructure. In total, 141 patients receiving classic tympanoplasty with PORP (N = 92), ossiculoplasty with PORP with ball joint (N = 22), or TORP (N = 27) between January 2011 and March 2017 were included in this study. The inclusion criterion was an intact stapes suprastructure. The underlying indication for surgery was either middle ear disease, such as cholesteatoma, or revision surgery for audiological improvement. The main outcome measures were four‐frequency pure tone average (0.5, 1, 2, 3 kHz) at early and late follow‐up after ossiculoplasty, the effects of clinical factors including the underlying middle ear disease, and primary or revision surgery. Results All patients showed a significantly reduced air‐bone gap (ABG 0.5, 1, 2, 3 kHz) at late follow‐up (mean: 18 dB) compared to preoperative measurements (mean: 25.5 dB). A significantly better outcome in ABG closure was shown among patients with a preoperatively intact tympanic membrane, with an intact stapes suprastructure or without preexisting cholesteatoma. Outcome was not significantly influenced by the prosthesis‐type, the creation of an open mastoid cavity, the status of the mucosa, or the indication for surgery. Conclusion TORP with an intact stapes suprastructure is a safe procedure and provides audiological outcomes similar to PORP. Level of Evidence 2C Laryngoscope, 130:768–775, 2020

Mapping the ChOLE classification to hearing outcomes and disease-specific health-related quality of life

“…It is hypothesized that the results of hearing restoration are comparable independently from the size of the cholesteatoma. This finding is well in accordance to existing studies demonstrating that even after largely extended cholesteatoma, a satisfying hearing restoration can be achieved [ 33 ].…”

“…It is hypothesized that the results of hearing restoration are comparable independently from the size of the cholesteatoma. This finding is well in accordance to existing studies demonstrating that even after largely extended cholesteatoma, a satisfying hearing restoration can be achieved [33]. Additionally, this study showed that a poorer status of the ossicular chain is associated with poorer pre-and postoperative hearing thresholds confirming earlier investigations on this concern [17].…”

“…Further, a trend to a poorer HRQoL associated with a poorer status of the ossicular chain was observed. Studies addressing the outcome of tympanomastoid surgery report that a preserved stapes suprastructure may lead to better hearing outcomes; whereas, large perforations, otorrhea and an absent malleus handle predict a worse audiological performance [ 7 , 12 , 34 , 35 ] and have an influence on the type of reconstruction [ 33 ]. These findings highlight the importance of the ossicular chain and are supported by the results of this study.…”

Comparison of hearing reconstruction techniques in tympanosclerosis with stapes fixation

“…Of course, the presence of cholesteatoma in patients with tympanosclerosis complicates the surgery. However, we believe that, with appropriate surgical treatment, it should not hinder achieving hearing gain, as also reported by Weiss et al [19].…”

Prosthesis extrusion post total ossicular replacement ossiculoplasty (TORP) following isotretinoin use: A case report and literature review of peri-operative isotretinoin safety

“…The surgical technique of ossiculoplasty performed using total ossicular replacement prostheses (TORP) is considered when the patient doesn't have malleus, incus, and stapes supra structures. It is commonly operated using interposed cartilage between the prostheses device and the tympanic membrane [ 3 ]. As a result, the use of cartilage graft has been shown to decrease surgery failure and prostheses extrusion [ 1 , 4 ].…”