Titanium incus interposition in ossiculoplasty: A retrospective study

This study aimed to evaluate the outcomes of ossiculoplasty using titanium incus interposition prostheses, focusing on audiological benefits, extrusion and dislocation rates.

This retrospective cohort study was conducted at a tertiary referral center and included 27 patients with conductive hearing loss who underwent ossiculoplasty using titanium incus interposition prostheses between 2015 and 2023. Preoperative and postoperative (minimum 6 months) otoscopic examinations and audiological assessments (average thresholds at 0.5, 1, 2, and 3 kHz) were performed. Patients were categorized as "stable" (n = 20, 74%) if the prosthesis remained functional, or as "failure" (n = 7, 26%) if reoperation was required for middle ear complications.

The mean postoperative air bone gaps (ABG) across 0.5-3 kHz were 19.6 (9.3) dB for all patients, and 16.1 (7.6) dB in the stable group. A total of 20 patients (74%) achieved either a postoperative ABG less than 20 dB or air conduction improvement more than 15 dB. Prosthesis dislocation occurred in 3 cases (11%), with a mean time of 31 months (range: 14-61 months). Extrusion was observed in 3 cases (11%), with a mean time of 25 months (range: 11-34 months). No significant difference in postoperative ABG or ABG closure was observed with respect to surgical indication, surgical approach, or the degree of temporal bone pneumatization.

Titanium incus interposition prostheses can provide satisfactory postoperative hearing in patients with an intact stapes, preserved malleus handle, and favorable ossicular alignment. Nevertheless, prosthesis displacement or extrusion occurred in 22% of cases, highlighting the need for improved design, biomaterials, and placement techniques to enhance long-term stability.