The sandwich cartilage shoe technique for ossicular reconstruction in a case of an unsecure stapes footplate

Outcomes of transcanal endoscopic middle ear surgery for congenital cholesteatoma

BACKGROUND

Transcanal endoscopic surgery offers advantages for congenital cholesteatoma (CC) which is expanding cystic mass located on an intact tympanic membrane.

OBJECTIVES

To determine the efficacy of transcanal endoscopic ear surgery for the treatment of CC.

MATERIAL AND METHODS

Eleven patients with CC confined to the middle ear underwent transcanal endoscopic ear surgery by surgeons who were skilled in otoscopic surgery. According to the Potsic classification, four, three, and four patients had lesions in stages 1, 2, and 3, respectively. The mean follow-up duration was 24.5 months. We retrospectively analyzed the recurrence rate, complications, and average hearing thresholds of the patients with CC.

RESULTS

All CCs were successfully resected via the transcanal endoscopic approach, without any immediate or serious complications. The only complication was external auditory canal stenosis due to postoperative scarring, which occurred in a patient with a stage-3 cholesteatoma that recurred and required reoperation and second-stage ossicular chain reconstruction. Two more patients underwent one-stage ossicular chain reconstruction. All three patients received a total artificial ossicular replacement prosthesis, and two of them also received cartilage grafts.

CONCLUSIONS AND SIGNIFICANCE

Transcanal endoscopic ear surgery is an effective method to treat CC belonging to Potsic stages 3 or below.

Long-term Follow-up Study of the Sandwich Cartilage Shoe Technique in Cases of Insecure Stapes Footplate

OBJECTIVE

Analysis of the audiometric results after repair of a defective footplate with the sandwich cartilage shoe technique in a follow-up study.

STUDY DESIGN

Retrospective analysis of audiometric data.

SETTING

Hospital.

PATIENTS

The cohort consisted of 12 patients, who underwent ossicular reconstruction after sandwich cartilage shoe technique in a case of insecure stapes footplate. The mean age was 42.7 years with an equal sex distribution. In every patient, cholesteatoma was the reason for surgery with 75% being revision cases.

INTERVENTION

Sandwich cartilage shoe technique in case of insecure stapes footplate at the department of otorhinolaryngology, head and neck surgery at the University of Cologne over an 8-year period (2007-2015).

MAIN OUTCOME MEASURE

The use of the "sandwich cartilage shoe technique" in case of a broken or unstable footplate allows a safe occlusion of the open vestibule.

RESULTS

The statistical analysis revealed a significant improvement of the pure-tone average (p = 0.011) and air-bone gap (ABG) (p = 0.016) after total ossicular replacement prosthesis (TORP) implantation. The hearing was stable at 9 months of follow up.

CONCLUSION

The sandwich cartilage shoe technique offers a safe and effective option as a two-stage procedure in treating patients with fractures of the stapes footplate in case of chronic otitis media. In view of the possible risk of deafness going along with a destruction of an inner ear window, our results can be considered substantial as all our patients will at least be able to regain "social hearing" as they all either achieved a hearing threshold is less than 30 dB or can be sufficiently supplied with a conventional hearing aid.

Stabilization of total ossicular replacement prosthesis using cartilage "shoe" graft

PURPOSE

We aimed to determine the effect of a cartilage shoe graft placed between the foot of the TORP and the stapes footplate on hearing improvement and long-term displacement rates.

MATERIALS AND METHODS

Patients who underwent TORP ossiculoplasty were divided into two groups. The TORP-alone group consisted of 32 patients who underwent TORP placement without cartilage shoe graft and served as the control group. The study group consisted of 56 patients who underwent placement of cartilage shoe graft together with TORP. Pure-tone audiometry was administered to all patients before and 3, 6 and 12 months after surgery. Indications for surgery, surgical technique used, postoperative complications, and air and bone conduction thresholds at 500, 1000, 2000 and 4000 Hz were recorded for all patients.

RESULTS

No significant difference in postoperative air-bone gaps was observed between the groups. The number of patients with air-bone gaps less than 20 dB was 14 (25%) in the study group and 8 (25%) in the control group. There was no significant difference in changes in air-bone gaps between the groups. Dislocation of the prosthesis was observed in 3 patients in the study group (5.3%) and 4 in the control group (12.5%). There was less dislocation of the prosthesis in the study group, but the difference was not statistically significant.

CONCLUSION

Placement of a cartilage graft between the footplate of the stapes and the foot of the prosthesis may have positive effects on long-term hearing improvement and rates of prosthesis displacement. Further research with larger patient numbers is needed to identify the advantages of shoe graft.

TORP Ossiculoplasty Outcomes with and without a Stapes Footplate Prosthesis

Objective

The titanium stapes footplate prosthesis (FPP) was designed to ensure a stable connection of a total ossicular replacement prosthesis (TORP) to the stapes footplate and maximize acoustic coupling by centering the footplate on the oval window. Our goal was to assess the impact of the FPP on TORP ossiculoplasty outcomes.

Study Design

Case series with chart review.

Setting

Tertiary care center.

Subjects

Adult patients undergoing TORP ossiculoplasty with (n = 53) or without (n = 108) a stapes FPP.

Methods

Rate of prosthesis displacement and audiologic outcomes were tabulated for statistical analysis.

Results

A lower rate of prosthesis displacement and statistically better audiologic outcomes were seen in FPP patients. The pure-tone average air-bone gap (PTA-ABG) was closed to <20 dB in 69.8% (37/53) of patients in the study arm and 44.4% (48/108) of patients in the control arm ( P = .003). The PTA-ABG was decreased by a mean ± SD of 19.3 ± 11.7 dB and 12.6 ± 11.0 dB in the study and control groups, respectively ( P = .0012).

Conclusions

Use of the titanium stapes FPP during TORP ossiculoplasty provides a statistically significant advantage in short-term PTA-ABG closure and a higher rate of successful rehabilitation of conductive hearing loss. Further studies are necessary to assess any long-term advantages a FPP may offer.