If ossicular reconstruction is ..

current Trends in Middle Ear Surgery Ossiculoplasty And Stapedioplasty With Titanium Prostheses

bone into the individual’s middle ear

Because of unacceptable extrusion and displacement of every prosthetic design, the author introduced two new prostheses for middle ear ossicular reconstruction: a new partial ossicular reconstruction prosthesis (modified double cartilage block), and a new semi-synthetic total ossicular replacement prosthesis (ssTORP).

Bone-Cement Usage for Ossicular Reconstruction.

The goal of surgical treatment is better hearing, most typically for conversational speech. Ossiculoplasty/Stapedioplasty surgery is being performed to improve orto maintain the conductive portion of hearing loss. The aim of ossiculoplasty/stapedioplasty surgery is to reconstruct the malfunctioning ossicular chain (chain of three bones i.e. Malleus, Incus & Stapes) in the middle ear cavity. Myringoplasty surgery is performed to ventilate the middle ear, to prevent fluid from building up and to prevent infections in the middle ear cavity. All the above mentioned surgical procedures take about an hour’s time and in most cases patients are discharged after 24-36 hours. During the 1960’s in the earliest stage of the development of surgical treatments, attempts were made to use biological materials such as cartilage or the remnants of the ossicular chain to create ossicular replacements. Such materials were termed auto-graft and homo-grafts materials since they were obtained from the person and donor respectively receiving the treatment.

AB - Postoperative otologic evaluation of patients who have undergone ossicular reconstruction is often difficult. However, thin-section computed tomography (CT) can help determine the type of prosthesis used for reconstruction and adequately assess for complications that may be causing postoperative conductive hearing loss. A variety of prostheses may be used in ossicular reconstruction (eg, stapes prosthesis, incus interposition graft, Applebaum prosthesis, Black oval-top prosthesis, Richards centered prosthesis, Goldenberg prosthesis) and can usually be identified at CT by their shapes and locations. Several causes of prosthetic failure are readily demonstrated at CT, including recurrent cholesteatoma and otitis media, formation of granulation tissue or adhesions, and various mechanical problems (eg, subluxation, dislocation, extrusion, fracture, bending). Perilymphatic fistula can be difficult to identify at CT but may be suggested by the presence of pneumolabyrinth, unexplained middle ear effusion, or fluid accumulation within the mastoid air cells. The presence of soft tissue within the oval window niche 4-6 weeks following surgery may indicate post-stapedectomy granuloma or fibrosis. Familiarity with the normal and abnormal CT appearances of ossicular prostheses will enable the radiologist to assist the otologist in identifying patients in whom revision surgery is most appropriate.

Ossicular Prostheses - Middle Ear Implants Titanium, …

Before antibiotics, mastoid surgery was commonly done in desperate circumstances for acute infection, a mastoid abscess. Our predecessors had nothing better than a hammer and gouge, and no magnification other than some spectacle loupes. It was counted a success if the patient – usually a young child – survived. No delicate work could be done, and most survivors were deafened. It was only after the introduction of the binocular operating microscope in the 1950’s that modern delicate controlled microsurgery of the ear became possible. Even with all the latest high powered microscopes, lasers and modern anaesthetics, mastoid surgery is very difficult. Surgeons have to train for years to get good at it. Like all ear surgeons trained since the 1960’s I did my basic training (in the 1980’s) on temporal bones from cadavers (dead bodies). Although some might find that macabre, I’d prefer the learning curve to be on my dead granny, rather than on my live child. The margin of error in mastoid surgery is measured in fractions of a millimetre. Anatomy varies considerably, and a surgeon needs to practice on lots of bones before embarking on live patients. Simulators and plastic bones just aren’t up to it. Unfortunately, in the UK, a public attitude has become established against the use of post-mortem tissues, which has led to a severe shortage of temporal bones for the next generation of ear surgeons to train on. I teach trainee surgeons ear surgery on live patients every week, sometimes two or three cases. The operations take anywhere between one to six hours. The average is around three hours.

Middle Ear Prosthesis with Bactericidal Efficacy—In …

Removing the disease takes priority. The surgeon has to tread a fine line between getting rid of the disease while preserving what he can of the hearing mechanism. Although cholesteatoma is not a tumour, it behaves like one. Unless the cholesteatoma is removed completely, it will come back. The surest way to get rid of the disease would be to drill out everything – be radical. But that would make you very deaf, and could damage the other structures we are trying to protect, like the balance organ and facial nerve. Cholesteatoma tends to infiltrate in lots of different directions. Sometimes it wraps itself around the ossicles. The most reliable way to make sure we don’t leave any behind on the ossicles would be to remove them altogether – but that would make you more deaf. In a radical mastoidectomy, all the ossicles are removed, except the footplate of the stapes. In some severe cases of cholesteatoma, the ossicles have already been eaten away by the disease so it makes no difference, they are gone anyway. Some of the most difficult areas to remove cholesteatoma are