Outcomes following ossicular chain reconstruction with composite prostheses: Hydroxyapatite-polyethylene vs. hydroxyapatite-titanium

June 11, 2013     Yoav Hahn, MD; and Dennis I. Bojrab, MD


We conducted a retrospective study to compare the results of ossicular chain reconstruction (OCR) with two types of composite prosthesis: a hydroxyapatite-polyethylene (HAPEX) implant and a hydroxyapatite-titanium (HATi) prosthesis. We reviewed the records of 222 patients-104 males and 118 females, aged 8 to 79 years (mean: 39.7)-who had undergone OCR for ossicular chain dysfunction and who met our eligibility criteria. In addition to demographic data and the type of prosthesis, we compiled information on pre- and postoperative audiometric findings, the underlying diagnosis, the timing of surgery (primary, planned, or revision), the type of surgery (tympanoplasty alone, tympanoplasty with antrotomy, intact-canal-wall tympanomastoidectomy, or canal-wall-down tympanomastoidectomy), the extent of reconstruction (partial or total), the use of the malleus, the use of a tragal cartilage graft, and evidence of extrusion. Of the 222 patients, 46 had undergone insertion of either a partial (n = 36) or total (n = 10) ossicular replacement prosthesis (PORP and TORP, respectively) made with HAPEX, and 176 had received a PORP (n = 101) or TORP (n = 75) made with HATi. Postoperatively, the mean air-bone gap (ABG) was 14.0 dB in the HAPEX group and 14.7 dB in the HATi group, which was not a significant difference (p = 0.61). Postoperative success (ABG ≤20 dB) with PORP was obtained in 30 of the 36 patients in the HAPEX group (83.3%) and in 87 of the 101 patients in the HATi group (86.1%), while success with TORP was achieved in 7 of 10 HAPEX patients (70.0%) and 56 of 75 HATi patients (74.7%); there was no significant difference in either PORP or TORP success rates between the HAPEX and HATi groups (p = 0.32). A significantly better hearing result was obtained when the malleus was used in reconstruction (p = 0.035), but the use of tragal cartilage led to a significantly worse outcome (p = 0.026). Revision surgery was associated with a significantly worse postoperative result (p = 0.034). Prosthesis extrusion was observed in 9.0% of all cases. The two types of composite assessed in this study yielded similar results in terms of functional hearing and stability, but the HATi prosthesis had some significant advantages. For example, it was associated with more cases in which the ABG closed to less than 10 dB. In addition, because of its thinner stem and lower profile, it can be used in situations that are not possible with the HAPEX implant.

Prediction of stapes footplate thickness based on the level of hearing loss in otosclerosis

August 10, 2012     Hadi Samimi-Ardestani, MD; Mohammadtaghi Khorsandi-Ashtiani, MD; Elmira Ghoujeghi, MD; Mohsen Rajati, MD; Mahtab Rabbani-Anari, MD; Aman Ghoujeghi, MD


During surgical treatment of a patient with otosclerosis, the probability of success depends in large part on the extent of the surgeon’s experience. Therefore, predicting the preoperative severity of disease may help determine the choice of surgeon based on how experienced the surgeon should be. We conducted a study to evaluate the relationship between hearing thresholds and footplate thickness in otosclerosis patients who underwent stapes surgery. We used a qualitative method for measuring footplate thickness that was based on the simplicity or difficulty of opening the footplate. Our study population was divided into two groups; group 1 was made up of 66 patients whose footplates were easily opened with low pressure or with repeated motions by hand, and group 2 was made up of 14 patients whose footplate was either opened by drilling or not opened because it had been obliterated. We found that the patients in group 2, who had more severe disease, had significantly higher air- and bone-conduction thresholds than did the patients in group 1. According to our findings, otosclerotic patients with high air- and bone-conduction thresholds generally have more severe disease and thus require a more experienced surgeon.

Congenital fixation of the head of the stapes in three family members

August 15, 2011     Stephen J. Wetmore, MD and Andrew F.L. Gross, MD


We conducted a retrospective chart review at a university hospital on a family that exhibited a rare cause of conductive hearing loss. Four male patients of this family had congenital conductive hearing loss. Three of these family members underwent bilateral ossiculoplasty, a father and two of his three sons. All three were found to have mild or moderate conductive hearing loss due to fixation of the head of the stapes by a bony bar that extended from the head of the stapes to the posterior ear canal wall. Surgical removal of the bony bar improved hearing in all cases. This family exhibits autosomal-dominant inheritance of this abnormality. Fixation of the head of the stapes by a bony bar that extends to the posterior ear canal wall is a rare cause of congenital, autosomal-dominant, mild or moderate conductive hearing loss that can be surgically corrected.

Traumatic perilymphatic fistula secondary to stapes luxation into the vestibule: A case report

April 30, 2011     Li-Ser Khoo, FRCR and Tiong-Yong Tan, FRCR


A penetrating ear injury with a perilymphatic fistula is not an uncommon occurrence in otolaryngologic practice, but stapes luxation is rare. We report the case of an 11-year-old boy who developed a traumatic perilymphatic fistula secondary to an atypical stapes luxation into the vestibule. After sustaining a penetrating injury to the right ear, the patient presented with otalgia, vertigo, vomiting, gait unsteadiness, and hearing loss. High-resolution computed tomography (HRCT) of the temporal bone detected pneumolabyrinth, indicating a perilymphatic fistula. The stapes had pivoted on the footplate at the oval window, and then it made an unusual 180° flip and luxated deeply into the vestibule, with the capitulum stapedis pointing medially. Conservative management was chosen in view of the high surgical risks posed by the deeply luxated stapes and the likelihood of a fracture of the stapes footplate. This case illustrates the importance of an accurate diagnosis and interpretation of a traumatic perilymphatic fistula and stapes luxation as seen on HRCT of the temporal bone.

Incus augmentation with glass ionomer cement in primary and revision stapes surgery

December 17, 2010     Gediz Murat Serin, MD, Behram Çam, MD, Ufuk Derinsu, PhD, Murat Sari, MD, and Çağlar Batman, MD


In stapedotomy, augmentation of the long process of the incus is necessary when the structure is too short or thin or when the bone has been eroded to the point that it is not possible to satisfactorily attach a piston prosthesis to it. One substance that has been used to augment the long process is glass ionomer cement (GIC). GIC is a dental bone cement that is finding new uses in otologic procedures. We conducted a retrospective study of 10 stapedotomies (6 primary and 4 revision cases) that included the use GIC to augment an insufficient long process. In all 10 cases, surgery was successful and without complication. A comparison of pre- and postoperative audiometry revealed significant improvements in mean air-conduction threshold and air-bone gap following surgery. Our findings suggest that GIC is safe and effective in augmenting the long process of the incus during both primary and revision stapedotomy.

Revision stapedectomy

December 1, 2009     William H. Lippy, MD, FACS and Leonard P. Berenholz, MD, FACS

Complete obstruction of the stapes footplate by a dehiscent facial nerve in stapedectomy

October 31, 2009     Vanessa S. Rothholtz, MD, MSc and Hamid R. Djalilian, MD

Applebaum incudostapedial prosthesis

August 31, 2009     James Lin, MD and Jose N. Fayad, MD

Preoperative considerations and indications for revision stapedectomy

July 31, 2009     William H. Lippy, MD, FACS and Leonard P. Berenholz, MD, FACS

Post-stapedectomy cochlear otosclerosis

March 31, 2009     Fred Linthicum Jr., MD

Extruding stapes prosthesis

January 1, 2009     Eric P. Wilkinson, MD and John W. House, MD

Primary stapedectomy: The surgery

December 1, 2008     William H. Lippy, MD, FACS and Leonard P. Berenholz, MD, FACS
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