Titanium stapes protheses in otosclerosis surgery

Introduction: The main techniques used today in stapes surgery are: stapedectomy (under 10%), partial posterior stapedectomy (small fenestra technique) and stapedotomy (more than 90%). The advantages of stapedotomy are: less trauma to the inner ear and a better stability of the prosthesis. The stapedotomy opening can be made with manual perforators, diamond microburr, laser beam or skeeter drill.Materials and methods: Between January 2006 and October 2011 a total of 162 patients were operated in the ENT Department of the University of Medicine and Pharmacy Timisoara, performing 183 procedures. We used titanium stapes prostheses of 0,4-0,6 mm diameter and 4.5, 4.75 mm lengths. The stapedotomy was performed with the manual perforators (majority of the cases) or with diamond microdrill (sometimes). 17 out of 162 patients were bilateral operated (10,49%). 15 out of 183 procedures were surgical revisions (8,19%). Results: A postoperative air-bone gap of 0 -10 dB was obtained in approximatively 90% of the cases. A partial sensorineural hearing loss, only on high frequencies, occurred in one patient (0,62%). Postoperative vertigo was rare and of short duration.Conclusion: The stapedotomy technique produces little trauma to the inner ear and good functional results. Titanium stapes prostheses have maximum biocompatibility, small weight, the most superior mechanical properties, such as elasticity, stability and stiffness

Tympanoossicular reconstruction in chronic noncholesteatomatous diseases of the middle ear

Introduction: The surgical reconstruction of the tympanoossicular system is named tympanoplasty. This includes the grafting of the tympanic membrane, named myringoplasty and the reconstruction of the ossicular chain through different types of ossiculoplasties. The objectives were to compare the results obtained with different types of grafting materials, we used in the reconstruction of the tympanic membrane and with different ossiculoplasty procedures. Methods: The study includes a total of 115 tympanoplasties in patients with noncholesteatomtous disease of the middle ear. In 31 of these cases the reconstruction of the ossicular chain was necessary. We used temporalis fascia for the reconstruction of the tympanic membrane in 42 cases and tragal perichondrium in 15. In the last years we introduced cartilage as grafting material and we used it in 58 tympanic membrane reconstructions. Incus interposition was the most frequently used ossiculoplasty procedure.Results: The rate of postoperative perforations and drum retractions was somewhat lower with the cartilage technique. The hearing results were comparable, but depended a lot on the status of the ossicular chain.Conclusion: In poor ventilated ears and in subtotal perforations cartilage seems to be a good option for eardrum reconstruction. The incus interposition is still a reliable method, if the ossicle is available and the basic situation is favorable

A comparison of cartilage and fascia in tympanoplasty for chronic noncholesteatomatous diseases of middle ear

Objective: To compare cartilage with fascia grafting in reconstruction of the eardrum after surgery for chronic noncholesteatomatous diseases of middle ear with respect to postoperative drum retraction and perforation and the hearing results. Material: Between Ianuary 2002 and December 2005 a total of 74 patients aged 18 to 55 underwent surgery for noncholesteatomatous diseases of middle ear. The eardrum was reconstructed using cartilage palisades or cartilage composite grafts in 32 cases and temporalis fascia in 42 cases. Postoperatively the patients were evaluated by otomicroscopy and audiometry. Results: All patients in the palisade group attended the follow-up examinations for at least one year. In the fascia group there were 2 patients that did not attend the follow-up examinations. In the cartilage group the mean follow up period was 20 months and 29 months in the fascia group. Two perforations (6%) and 4 (12%) retractions were found in the cartilage group versus 5 (12%) perforations and 6 (14%) retractions in the fascia group at the follow up. The hearing results were quite the same in the two groups. Conclusions: The comparison of fascia and cartilage for drum reconstruction after chronic noncholesteatomatous diseases of middle ear in adults indicates a slight advantage for the cartilage techniques in respect to prevention of drum retraction and perforation. The hearing results were quite the same in the two groups

Cartilage versus temporalis fascia in tympanplasty

Introduction: Retraction or perforation after reconstruction of the eardrum are well known problems in tympanoplasty. Different techniques and materials, including cartilage and temporalis fascia have been used in an attempt to prevent these problems.Today cartilage is more and more often used in middle ear surgery. It is therefore interesting to compare the outcomes in the short and long term with fascia grafting, which is still the most commonly used material.Methods: Between January 2002 and July 2009 a total of 182 patients aged 18 to 55 underwent surgery for noncholesteatomatous diseases of middle ear. The eardrum was reconstructed using cartilage palisades or cartilage composite grafts in 84 cases and temporalis fascia in 98 cases. The choice between the cartilage in both forms and fascia graft material was at random. Hearing was evaluated by two methods: absolute hearing( pure tone average ) and air-bone gap. For absolute hearing and air-bone gap, an average of thresholds at 500, 1000, 2000 and 4000 Hz was calculated. Hearing results were reported at 12 and 30 months.Results: All patients in the cartilage group attended the follow-up examinations for at least two years. In the fascia group there were 5 patients that did not attend the follow-up examinations. In the cartilage group the mean follow up period was 31 months and 35 months in the fascia group. We present and discuss our results regarding residual perforations, retractions and hearing.Conclusion: The results regarding the residual perforations and hearing are quite the same no matter the material used for the reconstruction. In poor ventilated ears cartilage seems to be a better option for eardrum reconstruction, but it requires a longer follow-up period