Titanium incus interposition ossiculoplasty: audiological outcomes and extrusion rates

Area of Science:

• Otolaryngology
• Biomaterials Science
• Audiology

Background:

• Ossiculoplasty aims to reconstruct the middle ear ossicular chain.
• Titanium incus prostheses offer a prosthetic alternative to autologous incus reconstruction.
• Long-term outcomes and failure rates of such prostheses require thorough evaluation.

Purpose of the Study:

• To evaluate the efficacy and safety of the Fisch titanium incus prosthesis in ossiculoplasty.
• To assess long-term audiological outcomes and identify factors influencing prosthesis success or failure.
• To compare the Fisch prosthesis with autologous incus use.

Main Methods:

• Prospective data collection from 139 patients undergoing ossiculoplasty with the Fisch titanium incus prosthesis (2001-2016).
• Analysis of 126 patients with at least 6 months follow-up (mean 4.5 years).
• Categorization into 'extrusion', 'failure' (reoperation), and 'stable' groups; audiological outcomes (air-bone gap) were measured.

Main Results:

• 75% of prostheses remained stable, 7% extruded, and 18% failed requiring reoperation.
• Mean postoperative air-bone gap (0.5-3 kHz) for the stable group was 15.3 dB.
• Atelectasis was the most common cause of extrusion; reoperations occurred at a mean of 30.7 months.
• No significant difference in outcomes based on cholesteatoma presence, surgical approach, or temporal bone pneumatization.

Conclusions:

• The Fisch titanium incus prosthesis is a reliable option for interposition ossiculoplasty, yielding hearing outcomes comparable to autologous incus.
• A stable prosthesis is associated with good long-term audiological results, with 81% achieving an air-bone gap below 20 dB.
• An expected air-bone gap of approximately 15 dB should be anticipated when using this titanium prosthesis.