Displacement of a Total Ossicular Replacement Prosthesis Following Ossicular Chain Reconstruction

Abstract

Objective: Herein we describe the diagnosis and management of total ossicular replacement prosthesis (TORP) displacement following tympanoplasty with ossicular chain reconstruction (OCR). Methods: Case report with literature review. Results/Case: A 40-year-old male with otorrhea and tympanic membrane perforation underwent a right revision tympanoplasty with OCR using a TORP with a tragal chondroperichondrial graft. On postoperative day (POD) 4, he developed vertigo and profound right-sided hearing loss. Temporal bone computed tomography showed the prosthesis in the vestibule. After a steroid taper with mild improvement in symptoms, the TORP was removed two weeks later and the patient continued to improve. Conclusion: TORP displacement into the vestibule is a very rare complication following OCR. Conservative management with high dose steroids may improve symptoms, however further middle ear exploration and surgical management may be warranted depending on the depth of displacement into the inner ear as well as symptom severity.

Minimal invasive surgery can cause devastating complications

“…Several papers reported vertigo related to the damage to the stapediovestibular junction [2,3]. Traumatic injury on the ossicular chain or prosthesis displaced into the vestibule manifests as positional vertigo and hearing loss [4][5][6]. Our reported case may be due to the problematic length of the reconstructed ossicular chain.…”