Some physical considerations in the choice of techniques for ossiculoplasty

A comparative study between the monobloc tympano-ossicular implant and the classical columellar technique is made. Although both give satisfactory audiometric results, the follow-up of the columellar restoration showed some post-operative disadvantages, namely: invagination and perforation of the tympanic membrane, slipping of the columella, and fixation of the columella to the tympanic ring (bony annulus) or to the promontory. In view of the normal tympano-malleal fixation, the normal static pressure accomodation in the incudo-malleal joint and the normal topological situation, monobloc implant obviates the disadvantages inherent in the columellar technique. Two aspects of the monobloc implant need further examination; these are the restoration of the correct rotation axes and the incudo-stapedial connection.