Middle ear reconstruction using the titanium Kurz Variac partial ossicular replacement prosthesis functional results
Faculty of Sciences. Physics
Faculty of Medicine and Health Sciences
JAMA otolaryngology, head and neck surgery / American Medical Association. - Chicago, Ill., 2013, currens
, p. 1017-1025
University of Antwerp
IMPORTANCE Satisfactory functional results following ossicular chain reconstruction mainly depend on a stable connection between the tympanic membrane and the stapes, which is in turn dependent on the type of prosthesis used. Knowledge about the safety and functional outcome of the commercially available middle ear prostheses is therefore of great importance. OBJECTIVE To evaluate the efficacy and safety of the Kurz TTP-Variac System partial ossicular replacement prosthesis (PORP) in ossiculoplasty. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of all ossiculoplasties performed by 1 surgeon at a secondary referral center from August 2006 through July 2012. Participants were patients with cholesteatoma, chronic otitis media, or ossicular chain disruption in the absence of inflammatory disease who underwent ossicular reconstruction. EXPOSURE Ossiculoplasty using a Kurz TTP-Variac System PORP. MAIN OUTCOMES AND MEASURES Mean preoperative and postoperative air-bone gaps (ABGs) and improvements in ABG were analyzed for each frequency by means of a 4-frequency pure-tone average. Successful postoperative hearing was defined as postoperative ABG smaller than 20 dB. RESULTS Eighty-nine ears in 83 patients aged 7 to 85 years were included. Transmeatal tympanoplasty was performed in 17 ears (19%). Seven ears (8%) underwent tympanoplasty with canal wall-down mastoidectomy, and 65 ears (73%) underwent canal wall-up (combined approach) tympanoplasty with mastoidectomy. The study population comprised 61 primary tympanoplasties (69%) and 28 revision cases (31%). Mean follow-up was 13 months. Overall, the ABG significantly improved from a mean (SD; range) of 26.19 (11.53; 3.75-51.25) dB to 15.58 (9.80; 0-48.75) dB (P < .01 for all frequencies). Mean ABG improvement was 10.62 dB. Successful postoperative hearing was obtained in 65 ears (73%). Revision surgery, especially in ears with ossicular chain disruption without inflammatory disease, was associated with poorer functional outcome, whereas preservation of the malleus was associated with a better functional outcome (P <.05). There were few complications (1 prosthesis extrusion, 2 prosthesis dislocations, 2 reperforations, 3 cases of residual cholesteatoma, and 3 of light sensorineural hearing loss). CONCLUSIONS AND RELEVANCE The titanium Kurz TTP-Variac System PORP is an effective prosthesis to reconstruct the ossicular chain. Complications are rare, illustrating the safety of the prosthesis.