Ossicular Chain Reconstruction With Titanium Prostheses: A Systematic Review and Meta-Analysis

Abstract

ObjectivesThis review sought to establish expectations for hearing improvement with specifically titanium partial (PORP) and total ossicular replacement prostheses (TORP) to give surgeons an acceptable goal for postoperative hearing results and to counsel patients on their expected results.Databases ReviewedMEDLINE/PubMed, EMBASE, and Cochrane Library.MethodsA systematic review of the literature was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE/PubMed, EMBASE, Cochrane library) were searched using relevant key search terms to identify studies evaluating outcomes of titanium prostheses. A title/abstract and full article review was then done, and the results from the remaining studies were analyzed with Review Manager 5.4 Software to perform a meta-analysis using a random-effects model.ResultsForty articles were analyzed after full article review based on the inclusion and exclusion criteria. For PORPs, the average improvement in air-bone gap (ABG) and pure-tone average were 12.1 and 13.5 dB, respectively. For TORPs, the average improvements in ABG and pure-tone average were 16.7 and 17.0 dB, respectively. Preoperatively, the average ABG was 7.0 dB better for PORP than TORP patients, and postoperatively, the ABG improved an average of 4.9 dB more for the PORP cohort. Seventy percent of PORPs and 57% of TORPs subjects had a postoperative ABG less than 20 dB.ConclusionsOverall, reconstruction of the ossicular chain with titanium prostheses reliably improves patients' hearing outcomes, and this study gives relevant information for counseling patients preoperatively on realistic hearing outcomes.

Titanium Biohybrid Middle Ear Prostheses: A Preliminary In Vitro Study

“…Titanium is reported to be an excellent material for synthetic ME prostheses because of its intrinsic properties: it is light, rigid, non-ferromagnetic, easy to handle during surgery, and it is a good sound wave conductor. In addition to this, its employment has been recorded in both adult and child cohorts [1]. However, this material is encumbered with a significant drawback shared by all synthetic ME prostheses currently in use: it can be rejected by the host organism, and this phenomenon is known as extrusion [1].…”

“…The modern approach to middle ear (ME) surgery, which combines both disease removal and functional reconstruction, dates back to the 1950s [1]. Ossiculoplasty (OPL) is an established surgical procedure intended to restore appropriate sound-wave transmission from the tympanic membrane to the oval window via a reconstructed ossicular chain [2].…”

“…Cadaveric homograft implants had ben employed until 1987, before being decommissioned due to the potential risk of infection [5]. In recent years, alloplastic prostheses have been designed with synthetic materials, such as metals, ceramics, plastics, and composites [1,8]. These prostheses are classified as Partial Ossicular Replacement Prostheses (PORP) when mounted upon the intact stapes, and Total Ossicular Replacement Prostheses (TORP) for cases with no stapes superstructure [9,10].…”

“…However, titanium prostheses also present downsides, due to early and late postoperative extrusion. A recent meta-analysis reports extrusion rates of 9% for the PORP cohorts and 15.65% for the TORP cohorts [1]. Recently, new potential tissue bioengineering options have been explored, to aid in overcoming extrusion risks [14,15].…”

Biopolymer‐based coatings for anti‐corrosion of Ti‐alloys used in biomedical applications: A review

“…Titanium and its alloys are also frequently utilized in knee joint replacements, which include a femoral component, a tibial component, and a patella (Figure 3). [36][37][38][39][40]…”