Titanium Prostheses for Treating Posttraumatic Ossicular Chain Disruption

Posttraumatic chain disruption may be caused by blunt head trauma, barotrauma, or a penetrating foreign body. In cases of severe damage to the incus, or its absence, a titanium prosthesis is a good option for reconstructing the ossicular chain.

A retrospective analysis was performed on 24 cases of posttraumatic ossicular chain disruption that had been treated with a titanium partial or total ossicular replacement prosthesis. Air conduction, bone conduction, and air-bone gap were measured before, 6-12 months after, and more than 2 years after the operation. Hearing thresholds were calculated as the mean of 4 frequencies (0.5, 1, 2, and 4 kHz).

The most common cause of ossicular chain disruption was blunt head trauma due to a traffic accident (9 of 24 cases), and there were also a diverse group of foreign bodies which caused damage. In cases where the incus was absent, or significantly damaged, titanium ossiculoplasties were performed (partial or total ossicular replacement prosthesis depending on the presence of the stapes superstructure). Analysis showed a significant improvement in average air conduction threshold and in air-bone gap after surgery (P < .05). Closure of the air-bone gap to within 20 dB was observed in 67% of patients.

Although posttraumatic ossicular chain disruption is not common, it is suspected whenever conductive hearing loss persists for several months after injury. In such cases, ossiculoplasty with a titanium prosthesis is likely to provide satisfactory audiological results.