TORP Versus PORP in Austin Type A Ossicular Defects: Which is the Right Choice?

Area of Science:

• Otolaryngology
• Biomedical Engineering
• Audiology

Background:

• Ossicular defects, common in chronic ear disease, necessitate reconstruction for hearing restoration.
• Total ossicular replacement prostheses (TORP) and partial ossicular replacement prostheses (PORP) are standard surgical options.
• Mechanical studies suggest malleus-to-footplate reconstruction may be biomechanically superior, but long-term outcomes comparing TORP and PORP in specific defect types remain unclear.

Purpose of the Study:

• To prospectively compare the long-term outcomes of TORP versus PORP in patients with Austin type A ossicular defects.
• To evaluate hearing gain, audiological (AB) gap closure, and prosthesis stability between the two reconstruction methods.

Main Methods:

• A prospective randomized trial involving 60 patients with Austin type A ossicular defects.
• Patients were divided into two groups: one receiving TORP reconstruction, the other receiving PORP reconstruction.
• Outcomes including pure tone average (PTA), air-bone gap (ABG) reduction, and prosthesis stability were assessed.

Main Results:

• Both TORP and PORP groups showed significant improvement in PTA, with postoperative hearing levels in the mild range (26-30 dB HL) for approximately 90% of patients.
• Mean hearing loss improved from moderate to severe conductive hearing loss preoperatively to mild postoperatively in both groups.
• ABG reduction was comparable between groups (TORP: 22.60 ± 12.34 dB; PORP: 17.79 ± 10.74 dB), but TORP exhibited greater prosthesis stability.

Conclusions:

• Hearing gain and ABG closure are similar with both TORP and PORP in Austin type A ossicular defects.
• TORP is recommended for better long-term outcomes due to its enhanced stability compared to PORP.
• This study provides evidence supporting TORP for stable and effective ossicular reconstruction in this patient cohort.