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A new prosthesis for reconstructing the incudostapedial joint
D M Nadel1, H Silverstein, M J Olds
1Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA.
Objective:
This study aimed to evaluate the hearing results obtained using the Silverstein Incus-Stapes Connection in ossicular reconstruction among patients with chronic ear disease.
Study Design:
The study was performed as a retrospective review. A control group consisted of patients undergoing similar surgery but in which no prosthesis was used.
Setting:
The Florida Ear and Sinus Center outpatient offices of the senior author.
Patients:
Forty-seven patients with a mean age of 48 years comprised the treatment group. Thirty-eight patients (mean age, 49.4 years) acted as control subjects.
Intervention:
All patients underwent surgery for chronic ear disease. Reconstruction surgery for patients requiring separation of the incudostapedial was performed with a Silverstein Incus-Stapes Connection or by reapproximating the joint capsule to allow primary healing.
Main Outcome Measure:
The patients were categorized according to how the prosthesis was used. Results comparing the preoperative air-bone gap and postoperative air-bone gap were evaluated. The change in air-bone gap was reported according to the guidelines set forth by the Committee on Hearing and Equilibrium.
Results:
The mean postoperative air-bone gap for reconstruction with the prosthesis was 17.6 dB compared to a mean of 11.8 dB among control subjects. An air-bone gap of 16.5 dB was achieved when the prosthesis was used to bridge an area of lenticular resorption. When a composite prosthesis, made by adding cartilage to the disk, was used to bridge larger defects, an air-bone gap of 14.3 dB was seen. Finally, when the prosthesis was used as a partial ossicular replacement prosthesis and directly contacted the tympanic membrane, the air-bone gap was 9 dB. The prosthesis was found to be stable when re-exploration was required and modification of the prosthesis with cartilage was accomplished easily intraoperatively.
Conclusion:
The Silverstein Incus-Stapes Connection is a middle ear prosthesis that can provide a mechanism for overcoming incus resorption in selected cases. In addition, the prosthesis can be modified easily with the addition of cartilage when needed.