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Updated: Jun 6, 2026
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The Microscopic Transcanal Approach in Stapes Surgery Revisited
Published on: February 16, 2022
Biocompatibility of nitinol stapes prosthesis
Christof Roosli1, Philipp Schmid, Alex M Huber
1Clinic of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland. christof.roeoesli@usz.ch
Summary
The SMart piston, a nitinol stapes prosthesis, demonstrated safe and effective fixation in revision stapedotomy. Morphological analysis revealed no nickel deposits or adverse mucosal reactions, confirming its safety for stapedial fixation.
Area of Science:
- Otolaryngology
- Biomaterials Science
- Surgical Innovation
Background:
- The SMart piston, a self-crimping nitinol prosthesis, offers potential advantages in stapes surgery by eliminating manual crimping.
- Concerns exist regarding potential thermal damage, incus strangulation, and nickel intolerance associated with nitinol prostheses.
Purpose of the Study:
- To morphologically assess the fixation of the SMart piston prosthesis to the incus.
- To investigate the middle ear mucosa's reaction to the prosthesis.
- To identify alterations in the incudal bone and detect nickel deposits.
Main Methods:
- Prospective analysis of four patients undergoing revision malleostapedotomy with prosthesis explantation.
- Utilized light and scanning electron microscopy, energy dispersive X-ray analysis, and atom absorption spectrometry for explant analysis.
Main Results:
- Tight circular fixation of prostheses was observed, with a minor lateral gap in one case.
- All prostheses were overgrown by mucosa, and superficial incudal bone erosion occurred in two cases.
- No elevation in nickel content was detected in tissue samples.
Conclusions:
- A lateral gap or mucosal coverage did not compromise prosthesis fixation.
- Incisal bone erosion was attributed to laser or prosthesis contact.
- Nitinol stapes prostheses are safe for treating stapedial fixation, with no evidence of increased nickel deposits.
