Bioactive ceramics versus proplast implants in ossiculoplasty.

Area of Science:

• Otolaryngology
• Biomaterials Science
• Surgical Innovation

Background:

• The widespread surgical use of alloplasts in otology has raised concerns regarding biocompatibility and structural stability.
• Long-term clinical surveys and histological findings necessitate a re-evaluation of existing ossicular reconstruction materials.

Purpose of the Study:

• To compare the long-term outcomes of ossiculoplasty using Proplast and Ceravital columellas.
• To assess hearing improvement, extrusion rates, and overall success of these alloplastic materials.

Main Methods:

• A retrospective study of 188 patients undergoing ossiculoplasty.
• Comparison of outcomes between Proplast (N=118) and Ceravital (N=70) columellas over one to five years postoperatively.
• Analysis of hearing gain, extrusion rates, and other failure causes.

Main Results:

• Ceravital demonstrated a 10% greater hearing improvement compared to Proplast.
• Significant percentages of patients in both groups did not achieve appreciable auditory gain (25% for Ceravital, 35% for Proplast).
• Ceravital had a lower extrusion rate (8%) compared to Proplast with cartilage interposition (18%).

Conclusions:

• While Ceravital offers better hearing outcomes and lower extrusion than Proplast, high rates of auditory gain failure persist.
• Successful columellar ossiculoplasty depends on realistic patient expectations, optimal surgical strategy, control of the primary disease, and prereconstructive anatomical conditions.
• Staging procedures for functional aims is a critical, potentially overlooked, factor for satisfactory outcomes in ossicular reconstruction.