TORP vs round window implant for hearing restoration of patients with extensive ossicular chain defect

Round window implant (RWI) with a floating mass transducer (FMT) may be suggested as the first choice in hearing rehabilitation for patients with chronic otitis media (COM) and extensive destruction of the ossicular chain.

To investigate the pros and cons of the total ossicular replacement prosthesis (TORP) vs the RWI in restoration of hearing in patients with COM.

Thirty-eight patients with bilateral moderate to severe mixed or conductive hearing loss from COM without cholesteatoma and bilateral ossicular chain erosion (footplate residual) were alternately assigned to a titanium-TORP (T-TORP) and to RWI with the FMT of the Medel Vibrant Soundbridge (MVBS) located onto the RW niche. The therapeutic efficiency, preoperative vs postoperative air-conduction gain and speech recognition were investigated for the two groups and statistically analyzed at 36 months postoperatively. The following postoperative anatomic conditions were also evaluated for the two groups: 1) recurrence of infection, 2) retraction pocket, 3) extrusion rate, and 4) displacement of the prosthesis.

Good functional results and stability at 36 months were obtained with both procedures. The extrusion rates for T-TORP were low. So far no extrusion has been observed for RWI. Hearing results were statistically much better for RWI vs T-TORP for all investigated parameters.