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Ossicular Chain Reconstruction With Titanium Prostheses: A Systematic Review and Meta-Analysis
Sarah Kortebein1, Alessandra Cataldo Russomando2, Dominik Greda1
1Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA.
Summary
Titanium prostheses, including partial (PORP) and total ossicular replacement prostheses (TORP), reliably improve hearing. This review provides surgeons and patients with expected hearing improvement outcomes for better preoperative counseling.
Area of Science:
- Otolaryngology
- Biomaterials Science
- Hearing Restoration
Background:
- Ossicular chain reconstruction is crucial for hearing restoration.
- Titanium prostheses offer a biocompatible solution for ossicular defects.
- Establishing clear expectations for hearing outcomes is vital for patient counseling.
Approach:
- Systematic review and meta-analysis of 40 studies evaluating titanium PORPs and TORPs.
- Searched MEDLINE/PubMed, EMBASE, and Cochrane Library for relevant literature.
- Analyzed data using Review Manager 5.4 Software with a random-effects model.
Key Points:
- Partial ossicular replacement prostheses (PORPs) showed average air-bone gap (ABG) and pure-tone average improvements of 12.1 and 13.5 dB.
- Total ossicular replacement prostheses (TORPs) yielded average ABG and pure-tone average improvements of 16.7 and 17.0 dB.
- PORPs demonstrated a greater postoperative ABG improvement (4.9 dB) compared to TORPs.
Conclusions:
- Titanium prostheses provide reliable hearing improvement in ossicular reconstruction.
- Seventy percent of PORP and 57% of TORP cases achieved a postoperative ABG < 20 dB.
- This study offers valuable data for setting realistic patient expectations regarding hearing outcomes.
