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Total Ossicular Chain Reconstruction: Is Autologous Material Better Than a TORP?
Nicholas S Andresen1,2, Filip Kostadinov2, Christoph Schlegel2
1Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH.
Summary
Total ossicular chain reconstruction using total ossicular replacement prostheses (TORPs) showed better hearing outcomes than autologous grafts. However, TORPs may have risks, and autologous cartilage is a viable option for specific patients.
Area of Science:
- Otolaryngology
- Audiology
- Biomaterials in reconstructive surgery
Background:
- Total ossicular chain reconstruction is a surgical procedure to restore hearing.
- Commonly used materials include autologous cartilage, autologous bone, and total ossicular replacement prostheses (TORPs).
- Comparative hearing outcomes between these reconstruction methods are not well-established.
Purpose of the Study:
- To compare hearing outcomes after total ossicular chain reconstruction using autologous materials versus TORPs.
- To identify factors influencing hearing results in ossicular reconstruction.
Main Methods:
- A prospective database of patients undergoing total ossicular chain reconstruction was queried.
- Preoperative and postoperative air-bone gaps (ABG) were compared between TORP and autologous graft groups.
- Multivariate analysis assessed the impact of revision surgery, canal wall down surgery, cholesteatoma, mucosal pathology, and pneumatization.
Main Results:
- TORP reconstruction resulted in significantly better improvement in air-bone gaps (ABG) compared to autologous grafts.
- Cholesteatoma and middle ear mucosal pathology were associated with poorer ABG improvement.
- Autologous bone grafts showed fusion in 28.6% of cases, and TORP extrusion occurred in 2.7% of cases.
Conclusions:
- Total ossicular replacement prostheses (TORPs) may provide superior hearing outcomes for total ossicular chain reconstruction compared to autologous grafts.
- Patients with cholesteatoma and middle ear mucosal pathology experience less favorable hearing outcomes.
- Autologous cartilage is a reasonable alternative in high-risk ears or when prosthesis extrusion is a concern.
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