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Displacement of a Total Ossicular Replacement Prosthesis Following Ossicular Chain Reconstruction
Aparna Govindan1,2, Rohini R Bahethi3, Zachary G Schwam1,2
1Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA.
The Annals of Otology, Rhinology, and Laryngology
|August 22, 2020
Summary
Total ossicular replacement prosthesis (TORP) displacement into the vestibule is a rare complication after ossicular chain reconstruction (OCR). Early steroid treatment may help, but surgical removal might be necessary for severe cases.
Area of Science:
- Otolaryngology
- Neurosurgery
- Medical Device Technology
Background:
- Tympanoplasty with ossicular chain reconstruction (OCR) aims to restore hearing in patients with middle ear defects.
- Total ossicular replacement prostheses (TORPs) are used to bridge the gap between the stapes footplate and the tympanic membrane remnant.
- Prosthesis displacement is a potential complication that can lead to hearing loss and other symptoms.
Observation:
- A case of a 40-year-old male who developed vertigo and profound hearing loss four days after revision tympanoplasty with OCR using a TORP.
- Temporal bone computed tomography revealed the TORP had displaced into the vestibule.
- Initial management included a steroid taper, which provided mild symptom improvement.
Findings:
- TORP displacement into the vestibule is an exceedingly rare complication following OCR.
- Surgical removal of the displaced TORP was performed two weeks postoperatively.
- The patient showed continued improvement after prosthesis removal.
Implications:
- This case highlights the importance of recognizing TORP displacement as a rare but serious complication.
- Conservative management with high-dose steroids may be attempted for symptom relief.
- Surgical intervention may be required based on the extent of inner ear displacement and symptom severity, necessitating careful consideration of risks and benefits.
