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Total ossiculoplasty: short- and long-term results using a titanium prosthesis with footplate shoe
Jose N Fayad1, Joseph Ursick, Derald E Brackmann
1*House Clinic and House Research Institute, Los Angeles, California; and †Otologic Center, Kansas City, Missouri, U.S.A. (previously, Clinical Fellow, House Clinic and House Research Institute, Los Angeles, California, U.S.A.).
Objectives:
Review experience using a titanium TORP with a footplate shoe; compare early and long-term hearing results and complications with those obtained using a TORP alone.
Study Design:
Retrospective chart review.
Setting:
Tertiary referral neurotologic private practice.
Patients:
Patients undergoing total ossicular replacement with a titanium prosthesis (total ossicular reconstruction prosthesis [TORP]); 74 with a TORP + footplate shoe and 62 with TORP alone.
Intervention:
Ossicular chain reconstruction with a titanium TORP.
Main Outcome Measures:
Short- and long-term air-bone gap (ABG), change in ABG from preoperative to postoperative and from postoperative to last recorded follow-up, sensorineural hearing loss.
Results:
The shoe group had a smaller mean postoperative ABG (17.7 dB versus 21.6 dB, p ≤ 0.048) and a greater average amount of closure in ABG (21.9 dB versus 13.2 dB, p ≤ 0.004), but there was no significant difference in percentage of patients achieving a postoperative ABG of 20 dB or lesser (57.4% versus 61.6%). There were no differences between groups at long-term follow-up or in amount of change in ABG from postoperative to last audiogram or in amount of change in sensorineural hearing from preoperative to postoperative. Although surgical factors (number of previous surgeries, and presence of a cavity) impacted outcomes, there were no interactions with prosthesis group and no differences in complications between groups.
Conclusion:
Ossicular reconstruction still presents challenges. A titanium prosthesis with a "shoe" for stabilization may offer advantages. Results in this study consistently favored the TORP + shoe group,although not all differences achieved statistical significance. A larger study might better define possible advantages of the shoe prosthesis for specific subgroups of patients.
