[Three years of experience with titanium implants in the middle ear]

In continuation of our previously published report on initial experience with titanium implants in the middle ear [13], we now present the results of routine use over a three year period.

From November 1994 to November 1997, 661 titanium implants (Düsseldorf model) were implanted in the authors' clinics (355 PORP, 306 TORP). There was no preselection of patients. Five hundred eighty-two follow up examinations were performed with a medium follow up time of 11.6 months.

The good initial results of the previous study with respect to biocompatibility and functional hearing results were confirmed in the long term follow-up. The average air-bone gap was calculated over the frequencies 0.5, 1, 2, and 4 kHz. Closure to within 20 dB was achieved in 72% of cases. The air-bone gap tended to decrease with increasing time of implantation. Adverse reaction to the prostheses did not occur. Extrusion occurred in one case of complete middle ear atelectasis with resorption of the interposed cartilage. Insufficient improvement of hearing was attributable to a short implant in 12 cases (1.8%). In three cases (0.5%) insufficient stability of the PORP was attributable to eroded stapes suprastructure, and in three others (0.5%) a dislocation was responsible for a poor hearing result. Middle ear fibrosis with impairment of sound transmission was seen in 3 patients (0.5%).

The superior acoustic properties of the delicate yet rigid low-weight titanium implants combined with excellent biocompatibility lead to a good hearing result if a meticulous surgical technique is employed. The easy handling makes it a pleasure to work with these protheses.