Histopathology of Ossicular Grafts and Implants in Chronic Otitis Media

Abstract

Autogenous malleus, incus, and cortical bone grafts behaved in a similar manner and maintained their morphological size, shape, and contour for extended periods of time, at least up to 30 years. These histopathologic observations support the continued use of autograft ossicular and cortical bone grafts for middle ear reconstruction. Cartilage grafts developed chondromalacia with resulting loss of stiffness and showed a tendency to undergo resorption. Synthetic prostheses made of porous plastic (Plastipore, Polycel) elicited foreign body giant cell reactions with various degrees of biodegradation of the implants. Prostheses made of hydroxyapatite and Bioglass were enveloped by a lining of connective tissue and mucosal epithelium. The Bioglass material was broken down into small fragments and partially resorbed by a host response within the middle ear. These results warrant caution in the use of prostheses made of porous plastic or Bioglass.

Mechanical treatment and autoclaving of middle ear ossicles from cholesteatomatous ears

“…The autologous malleus and incus have been used for tympanoplasty because of their biocompatibility, easy availability, good sound conduction and low cost of preparation [11][12][13][14][15]. Autograft ossicles maintain their contour, size, shape and physical integrity for long time, spanning at least 25 years [15][16][17].…”

“…Autograft ossicles maintain their contour, size, shape and physical integrity for long time, spanning at least 25 years [15][16][17]. Viability of ossicular autograft is not necessary from functional standpoint.…”

“…Viability of ossicular autograft is not necessary from functional standpoint. Grafts that consist of nonviable bone appear to maintain their morphological structure and integrity and transmit sound as well as those consisting of viable bone [15][16][17]. However, their use in patients with cholesteatoma has been limited by the risk of harbouring residual disease.…”

Adaptive Immunity in the Middle Ear Mucosa with Chronic Otitis Media

“…While in the middle ear, this is not the case. Middle ear homografts are usually not subject to a frank immunologic rejection [8] although inflammation occurs [9]. It has long been recognized that there is immunotolerance towards ossicular grafts and tympanic membrane implants.…”

Cartilage Palisades in Type 3 Tympanoplasty: Functional and Hearing Results

“…Certain conditions, however, mandate a type 3 ossicular reconstruction due to ossicular erosion (resorptive osteitis, cholesteatoma induced) or ossicular disarticulation and removal for epitympanic disease clearance [2]. This can be associated with poorer hearing outcomes due to the primary pathology itself or the less than optimal prosthesis designs, materials and implant extrusions [3,4].…”