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Pediatric ossiculoplasty with titanium total ossicular replacement prosthesis
Nikolaus E Wolter1, Theresa Holler, Sharon L Cushing
1Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario.
Insights
Titanium total ossicular replacement prostheses (TORPs) provide effective hearing restoration in children. However, hearing gains may decrease over time, necessitating monitoring and potential revision surgery.
Area of Science:
- Otolaryngology
- Audiology
- Biomaterials in reconstructive surgery
Background:
- Ossicular reconstruction is crucial for hearing restoration in children with middle ear defects.
- Titanium total ossicular replacement prostheses (TORPs) are utilized for this purpose.
Purpose of the Study:
- To evaluate the medium-term effectiveness of titanium TORPs in pediatric patients undergoing ossicular reconstruction.
- To assess hearing outcomes and prosthesis durability over time.
Main Methods:
- A case series of children (aged 7-18) receiving titanium TORPs was analyzed.
- Audiometric testing (air and bone conduction, air-bone gap) was performed preoperatively and at regular intervals postoperatively.
- Kaplan-Meier analysis assessed the proportion of successful outcomes (≤30 dB HL AC).
Main Results:
- 75 TORPs were implanted in 71 children with a median follow-up of 2.7 years.
- At 1 year, mean AC PTA was 35 dB HL and ABG was 29 dB, with 14 dB ABG closure.
- 50% achieved successful hearing outcomes initially; however, 10% experienced deterioration by 1-3 years. Four revisions were performed.
Conclusions:
- Titanium TORPs are an effective option for pediatric ossicular reconstruction with low short-term extrusion rates.
- Initial hearing improvements are generally maintained through the first year but may decline in subsequent years.
Objectives/Hypothesis:
To assess the medium-term efficacy of total ossicular reconstruction with a titanium total ossicular replacement prosthesis (TORP) in children.
Study Design:
Case series.
Methods:
A consecutive series of children receiving an adjustable-length titanium TORP was identified from a prospective surgical and audiological database. Audiometric testing was obtained preoperatively, 2 months postoperatively, and subsequently at 6- to 12-month intervals. Four-frequency pure-tone averages (PTA) were determined for air conduction (AC) and bone conduction thresholds, as well as air-bone gap (ABG). Pre- and postoperative measures were compared to determine degree of improvement. The proportion with successful outcome (defined as ≤ 30 dB hearing level [HL] AC) was determined over time with Kaplan-Meier analysis.
Results:
Seventy-five TORPs were inserted in 71 children aged 7 to 18 years, with a median follow-up of 2.7 years (0.6-5.5 years). The mean postoperative PTA AC threshold and ABG at 1 year were 35 dB HL and 29 dB, respectively, with ABG closure of 14 dB. The maximum gain in AC was 40 dB, achieved in eight (11%) cases. Successful outcome was seen in 50% of children at first follow-up. Over the following 1 to 3 years, hearing levels deteriorated to AC > 30 dB HL in an additional 10% of patients. Four patients had revision surgery, one for prosthesis extrusion and three for a lack of improvement in hearing.
Conclusions:
Titanium TORPs offer children an effective method of ossicular reconstruction, with infrequent extrusion at least in the short term. The hearing improvement achieved in the early postoperative period appears to be maintained over the first year but may not be sustained over longer time periods.
