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The Auditory Ossicles

The Auditory Ossicles

The auditory ossicles of the middle ear transmit sounds from the air as vibrations to the fluid-filled cochlea. The auditory ossicles consist of two malleus (hammer) bones, two incus (anvil) bones, and two stapes (stirrups), one on each side. These bones develop during the fetal stage and are the ones to ossify first. They are fully mature at birth and do not grow afterward.
The aptly named stapes look very much like a stirrup. The three ossicles are unique to mammals, and each plays a role in...

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Titanium incus interposition in ossiculoplasty: A retrospective study.

Wanru Zheng^1,2, Qingsong Liu³, Huiying Sun¹

¹Department of Otorhinolaryngology Head and Neck Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

|January 6, 2026

Summary

Titanium incus interposition prostheses offer good hearing outcomes for ossiculoplasty patients with intact stapes. However, a notable rate of prosthesis dislocation and extrusion necessitates further improvements in design and surgical techniques for long-term stability.

Keywords:

Hearing loss Incus Ossicular prosthesis Titanium Tympanoplasty

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Area of Science:

Otolaryngology
Biomaterials Science
Surgical Innovation

Background:

Conductive hearing loss often requires surgical intervention like ossiculoplasty.
Titanium prostheses are utilized in ossiculoplasty to restore the ossicular chain.
Evaluating the long-term efficacy and complications of these prostheses is crucial.

Purpose of the Study:

To assess the audiological outcomes of ossiculoplasty using titanium incus interposition prostheses.
To determine the rates of prosthesis extrusion and dislocation.
To identify factors influencing the success of titanium incus interposition prostheses.

Main Methods:

A retrospective cohort study of 27 patients undergoing ossiculoplasty with titanium incus interposition prostheses (2015-2023).
Preoperative and postoperative audiological assessments and otoscopic examinations were performed.
Patients were classified as stable or failure based on prosthesis function and need for reoperation.

Main Results:

A significant proportion of patients (74%) achieved satisfactory hearing improvement (ABG < 20 dB or AC improvement > 15 dB).
The stable group showed a mean postoperative air-bone gap (ABG) of 16.1 dB.
Prosthesis dislocation and extrusion each occurred in 11% of cases, with a mean onset time of 25-31 months post-surgery.

Conclusions:

Titanium incus interposition prostheses can yield favorable hearing results in select ossiculoplasty patients.
A combined 22% rate of prosthesis displacement or extrusion was observed.
Enhancements in prosthesis design, biomaterials, and surgical techniques are needed to improve long-term stability.