Histology of Extruded Plasti‐Pore Ossicular Prostheses

Gamoletti, Roberto; Bellomi, A; Sanna, Mario; Zini, C; Scandellari, R

doi:10.1177/019459988409200319

Cited by 11 publications

(6 citation statements)

References 11 publications

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“…However, light-and electron-microscopic in vivo animal studies identified foreign body reactions adjacent to the implant and phagocytic consumption of the material [48]. Explanted prostheses showed microscopic desintegration after years of implantation and microrganisms were regularly found in the pores of extruded prostheses [49][50][51][52]. The experimental reservations of many authors about this materials are in accordance with long term clinical observations reporting extrusion rates as high as 60 % and poor long term hearing results [51,53].…”

Section: Polyethylenesupporting

confidence: 60%

Biomaterials for ossicular chain reconstruction. A review

Neumann

Jahnke

2003

Materialwissenschaft Werkst

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This review gives a survey of biomaterials used for ossicular chain reconstruction. The survey is focussed on application, biophysical requirements, properties and goals for future developments. The implantation site middle ear differs from others due to aeration and potential bacterial colonization. As a consequence, implant materials must exhibit excellent biocompatibility, biostabilty and sound conducting properties. In vitro and in vivo biocompatibility investigations and clinical observations determine the choice of material. Additionally the implants must provide the possibilty of intraoperative shaping or should be available in different variations in order to allow reconstruction appropriate to the individual conditions. Ceramics, metals and plastics are materials in current use. Based on thorough experimental and long term clinical experiences, the bioinert aluminum oxide is favorable amoung the ceramics. Bioactive ceramics may have minor biostability and the risk of fixation to surrounding bone which impairs sound conduction. This is also true for hydroxyapatite although biodegradation occurs only rarely. Today, titanium is the metal best established in middle ear implantation, reflected by excellent biocompatibility in vitro and in vivo, and good clinical results. Titanium is preferred by many surgeons, considering that sound transmission properties are mainly dependent on the implant weight. In stapes surgery, when the implant has direct contact to inner fluids, gold was accused to cause granuloma formation with subsequent inner ear damage in selected cases. In frequent past and present use, plastics (porous polyethylene and teflon) have proven to be of limited value in ossicular chain replacement because of high extrusion rates and the observation of material desintegration and bacterial colonization. In order to individually manage the pathological conditions in the middle ear, the implant design is of crucial importance. It is dependent on the ossicle to be replaced and the implant material. Future investigations have to minimize implant extrusions possibly by modifying and improving implant surfaces.

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Section: Polyethylenesupporting

confidence: 60%

Biomaterials for ossicular chain reconstruction. A review

Neumann

Jahnke

2003

Materialwissenschaft Werkst

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“…Zumindest sind bei explantierten Kunststoffprothesen regelmäßig Bakterien nachzuweisen gewesen [6]. Zumindest sind bei explantierten Kunststoffprothesen regelmäßig Bakterien nachzuweisen gewesen [6].…”

Section: Für Die Manifestation Einer Infektion Sind Zahl Und Aggressiunclassified

Bakterielle Besiedlung von Implantaten in der Nebenhöhlen- und Ohrregion

G¹

2001

HNO

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Im Fokus | HNO 5•2001 340Während bei Permanentimplantaten wie Gefäßprothesen oder künstlichen Gelenken eine bakterielle Kontamination katastrophale Folgen meist mit Implantatabstoßung hat, scheint ein Einbringen von biokompatiblen Werkstoffen in das bakteriell besiedelte Nebenhöhlensystem oder die Mittelohrregion möglich zu sein. Allerdings spielen Art des Materials, seine Oberflächengestaltung, die Kontaktfläche zum Gewebe, die materialbedingte antibakterielle Aktivität sowie Art und Zahl der vorhandenen Bakterien -wie auch in anderen Körperregionen -bei der Integration des Werkstoffs eine Rolle. Die Kenntnis der Wechselwirkung zwischen Implantat und dem bei Infekten zu erwartenden Keimspektrum sollte bei der Auswahl eines möglichen Knochenersatzmaterials für die Ohr-und Nebenhöhlenregion berücksichtigt werden. Der Anwender wird beim Hersteller zunehmend anfragen, wie sich ein unter In-vitro-und In-vivo-Bedingungen geprüftes Material in (primär) kontaminierter Operationsregion verhält. Eineantibakterielle Materialaktivität ist wünschenswert, ein indifferentes Verhalten sicherlich akzeptabel.Werkstoffanteile sollten allerdings nicht für das Wachstum des Mikroorganismus nutzbar sein (z. B. einige Kohlenstoffwerkstoffe oder PMMA). Im Fokus HNO 2001 · 49:340-343

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“…Kleinere Partikel wurden phagozytiert, wobei diese Beobachtungen für Polycel-, Plastipore-und Proplastprothesen galten [103]. In den Poren abgestoßener Prothesen fanden sich regelmäßig bakterielle Mikroorganismen [5,34,91,92].…”

Section: Klinische Anwendungunclassified

“…Der Endplatte aufgelegte Knorpelscheiben reduzierten die Abstoßungsrate auf 10-15% [21,34,78]. Der Endplatte aufgelegte Knorpelscheiben reduzierten die Abstoßungsrate auf 10-15% [21,34,78].…”

Section: Klinische Anwendungunclassified

Materialien zur Rekonstruktion des Schalleitungsapparats

1999

HNO

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To rehabilitate most cases of conductive hearing loss closure of ear drum perforations and rebuilding of the ossicular chain can be performed. Due to the great number of biocompatible bone substitute materials available it is occasionally difficult for the surgeon to choose the most favorable substitute. Autogenous structures (ossicles, cortical bone, cartilage) and allogenous tissues (ossicles, cortical bone, cartilage, dentin) are possible bone replacement materials. Xenogenic tissue is currently not used in middle ear surgery. Ionomer cement is a hybrid material for replacement of bone but does not fit direct classification of the various classes of alloplastic materials in current use: that is, metals (gold, steel wire, platinum, titanium), plastics (polyethylene, polytetrafluorethylene) and ceramics (ceramic oxide, carbon, calcium-phosphate ceramic, vitreous ceramic). For restoration of the sound conductive apparatus preference is given to autogenous ossicles because cortical bone is resorbed and cartilage weakens over time. Most surgeons do not use allogenous tissue, because of the possible transmission of such infectious disease as immunodeficiency syndrome or Creutzfeldt-Jakob disease. Only dentin deserves special attention as a possible bone substitute in the middle ear because its form can be preserved during sterilization. Based on the observations available to date, it becomes apparent that titanium implants hold greater promise than gold. Form-stable synthetic materials are not generally recommended due to foreign body reactions which have been confirmed by many investigators. Ceramic materials (e.g. ceramic oxide, carbon, calcium-phosphate ceramic, glass ceramic) are well tolerated in the middle ear and have also proved to be useful over time. Hybrid bone substitute ionomer cement is easily workable and well integrated, showing a good functional outcome. For many years good results in otosclerosis surgery have been achieved with a prosthesis made of platinum-wire and Teflon. Short-term follow-up periods hold great promise with pistons made of gold. Autogenous ossicles, ionomer cement and recently titanium protheses--as far as usable--are employed by the author for reconstructing the middle ear. For the time being platinum-Teflon prostheses and gold are used in otosclerosis surgery.

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Histology of Extruded Plasti‐Pore Ossicular Prostheses

Cited by 11 publications

References 11 publications

Biomaterials for ossicular chain reconstruction. A review

Biomaterials for ossicular chain reconstruction. A review

Bakterielle Besiedlung von Implantaten in der Nebenhöhlen- und Ohrregion

Materialien zur Rekonstruktion des Schalleitungsapparats

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