Universität zu Köln

Gostian, Antoniu-Oreste, Kouame, Jean-Marc, Bremke, Martin, Ortmann, Magdalene, Huettenbrink, Karl-Bernd and Beutner, Dirk (2016). Long-term Results of the Cartilage Shoe Technique to Anchor a Titanium Total Ossicular Replacement Prosthesis on the Stapes Footplate After Type III Tympanoplasty. JAMA Otolaryngol-Head Neck Surg., 142 (11). S. 1094 - 1100. CHICAGO: AMER MEDICAL ASSOC. ISSN 2168-619X

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Abstract

IMPORTANCE Multiple techniques for a more secure and stable anchoring of the foot of a total ossicular replacement prosthesis (TORP) on the footplate have been proposed. To address this issue, a technique was developed that fits a cartilage shoe into the oval niche to guide the base of the prosthesis into a preformed central perforation. OBJECTIVE To evaluate the long-term results of the cartilage shoe technique used to anchor a titanium TORP on the stapes footplate in patients after type III tympanoplasty. DESIGN, SETTING, AND PARTICIPANTS Medical record review of total ossiculoplasties at a single center. The study included all patients who had undergone a tympanoplasty using a TORP between January 1, 2004, and December 31, 2008, at the Department of Otorhinolaryngology-Head and Neck Surgery, University of Cologne, Cologne, Germany. MAIN OUTCOMES AND MEASURES Hearing thresholds were determined by a 4-frequency (500-4000 Hz) pure-tone average air-bone gap (PTA-ABG). Intraoperative findings from revision surgery and second-look operations are reported. RESULTS Forty-two ears were eligible for follow-up examination, averaging 6.8 years (range, 4.8-9.1 years) after surgery, that comprised otoscopy and audiometry. The mean age of 22 women and 20 men was 42.8 years (age range, 6-78 years). The overall PTA-ABG decreased from a mean (SD) of 33.0 (8.4) decibels (dB) before surgery to a mean (SD) of 22.0 (10.1) dB after surgery (P <= .001, eta = 0.402). Before surgery, 64% (27 of 42) of the patients had a PTA-ABG exceeding 30 dB, which was 30 dB or less in 76% (32 of 42) of the patients after surgery. After canal wall down (n = 18) and tympanoplasties with intact canal wall (n = 24), the PTA-ABG was reduced from a mean (SD) of 33.0 (8.9) dB to 24.6 (11.2) dB (P = .01, eta = 0.271) and from a mean (SD) of 32.0 (7.3) dB to 19.6 (9.2) dB (P <= .001, eta = 0.511), respectively. For transmeatal revision ossiculoplasty (n = 33), the PTA-ABG improved from a mean (SD) of 32.0 (8.6) dB to 21.0 (10.2) dB (P <= .001, eta = 0.389), similar to primary ossiculoplasty (n = 9), with a mean (SD) of 33.0 (5.5) dB PTA-ABG before surgery and a mean (SD) of 21.0 (9.8) dB PTA-ABG after surgery (P = .005, eta = 0.478). Intraoperative findings from revision surgery (n = 11) during the study period and second-look procedures (n = 7) showed that the cartilage shoe prevented a lift off the footplate in all but 2 patients, even in the presence of recurrent cholesteatoma. CONCLUSIONS AND RELEVANCE The use of the cartilage shoe that anchors a titanium TORP on the stapes footplate can be advocated for good and reliable long-term results after total ossiculoplasty.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gostian, Antoniu-Oreste UNSPECIFIED UNSPECIFIED UNSPECIFIED Kouame, Jean-Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Bremke, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Ortmann, Magdalene UNSPECIFIED UNSPECIFIED UNSPECIFIED Huettenbrink, Karl-Bernd UNSPECIFIED UNSPECIFIED UNSPECIFIED Beutner, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-256757
DOI:	10.1001/jamaoto.2016.2118
Journal or Publication Title:	JAMA Otolaryngol-Head Neck Surg.
Volume:	142
Number:	11
Page Range:	S. 1094 - 1100
Date:	2016
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	2168-619X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CANAL WALL; CHAIN RECONSTRUCTION; OSSICULOPLASTY; MASTOIDECTOMY; IMPLANTS; SURGERY; TORPS Multiple languages Otorhinolaryngology; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/25675