The Restorative Effects of Three Commonly Used Materials on Hearing Thresholds in Patients with Austin-Kartush Type A Ossicular Defects

Year 2022, Volume: 32 Issue: 4, 110 - 114, 24.01.2023

Harun Gür , Kemal Koray Bal , Kemal Görür , Onur İsmi , Yusuf Vayısoğlu , Cengiz Özcan

https://doi.org/10.26650/Tr-ENT.2022.1210810

Abstract

Objective: This study aims to compare the effect on the hearing results of three different materials used in ossiculoplasty for patients with chronic otitis media (COM) and Austin-Kartush type A defect. Materials and Methods: This retrospective study includes 79 patients with the Austin-Kartush type A defect due to COM. The ossiculoplasty had been performed with a glass ionomer cement (GIC), titanium partial ossicular replacement prosthesis (PORP), or incus interposition between 2011-2021. Age, gender, operation side, hearing thresholds, computed tomography images, intraoperative findings, and middle ear risk index (MERI) were obtained from medical records. Air-conduction (AC) and bone-conduction (BC) thresholds were calculated by averaging the threshold values for 500, 1,000, 2,000 and 3,000 Hz, and air-bone gap (ABG) values were calculated by subtracting the BC thresholds from the AC thresholds, preoperatively and postoperatively. Hearing gains were obtained by subtracting ABG values in the first postoperative year from the preoperative ABG values. Results: This study included 32 male and 47 female patients. The GIC group had 28 patients, the incus interposition group had 28, and the PORP group had 23. No statistically significant difference occurred among the groups regarding MERI scores (p = 0.699). The mean preoperative ABG levels were 37.46±9.23dB in the GIC group, 38.96±11.35dB in the incus interposition group, and 37.34±10.16dB in the PORP group, while the mean postoperative ABG levels were 24.42±11.20dB in the GIC group, 23.25±10.09dB in the incus interposition group, and 22.82±13.59dB in the PORP group (p = 0.814). The ABG gains were 13.75±11.66dB in the GIC group, 15.71±11.55dB in the incus interposition group, and 14.52±9.98dB in the PORP group (p = 0.803). Conclusion: The incus long process defect or lack of the incus due to COM may be repaired with GIC, incus interposition, or titanium PORP, all with similar ABG gains.

Keywords

Chronic otitis media, ossiculoplasty, Austin-Kartush type A defect, glass ionomer cement, incus interposition, partial ossicular replacement prosthesis

References

• 1. McGee M, Hough JVD. Ossiculoplasty. Otolaryngol Clin North Am 1999;32(3):471-88. google scholar
• 2. Chole RA, Skarada DJ. Middle ear reconstructive techniques. Otolaryngol Clin North Am 1999;32(3):489-503. google scholar
• 3. Ozer E, Bayazit YA, Kanlikama M, Mumbuc S, Ozen Z. Incudostapedial rebridging ossiculoplasty with bone cement. Otol Neurotol 2002;23(5):643-6. google scholar
• 4. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg 1995;113(3):186-7. google scholar
• 5. Guler I, Kum RO. Management of Incus Defects in Children: Comparison of incus transposition versus glass ionomer cement. Ear Nose Throat J 2021;100(2):97-102. google scholar
• 6. O’Reilly RC, Cass SP, Hirsch BE, Kamerer DB, Bernat RA, Poznanovic SP. Ossiculoplasty using incus interposition: hearing results and analysis of the middle ear risk index. Otol Neurotol. 2005;26(5):853-8. google scholar
• 7. Smyth GD. Five-year report on partial ossicular replacement prostheses and total ossicular replacement prostheses. Otolaryngol Head Neck Surg 1982;90(3 Pt 1):343-6. google scholar
• 8. Brook IM, Hatton PV. Glass-ionomers: bioactive implant materials. Biomaterials 1998;19(6):565-71. google scholar
• 9. Yazıcı H, Uzunkulaoğlu H, Emir HK, Kızılkaya Z, Doğan S, Samim E. Comparison of incus interpositioning technique versus glass ionomer cement application in type 2 tympanoplasty. Eur Arch Otorhinolaryngol 2013;270(5):1593-6. google scholar
• 10. Dere H, Ozdogan F, Ozcan KM, Selcuk A, Ozcan I, Gokturk G. Comparison of glass ionomer cement and incus interposition in reconstruction of incus long process defects. Eur Arch Otorhinolaryngol 2011;268(11):1565-8. google scholar
• 11. Rupa V, Krishnaswami H, Job A. Autograft ossicle selection in cholesteatomatous ear disease: histopathological considerations. J Laryngol Otol 1997;111(9):807-9. google scholar
• 12. Dornhoffer JL, Colvin GB, North P. Evidence of residual disease in ossicles of patients undergoing cholesteatoma removal. Acta Otolaryngol 1999;11(1)9:89-92. google scholar
• 13. Siddiq MA, East DM. Long-term hearing results of incus transposition. Clin Otolaryngol Allied Sci 2004;29(2):115-8. google scholar
• 14. Krueger WWO, Feghali JG, Shelton C, Green JD, Beatty CW, Wilson DF et al. Preliminary ossiculoplasty results using the Kurz titanium prostheses. Otol Neurotol 2002;23(6):836-9. google scholar
• 15. Meister H, Walger M, Mickenhagen A, von Wedel H, Stennert E. Standardized measurements of the sound transmission of middle ear implants using a mechanical middle ear model. Eur Arch Otorhinolaryngol 1999;256(3):122-7. google scholar
• 16. Schwager K. Titanium as a biomaterial for ossicular replacement: results after implantation in the middle ear of the rabbit. Eur Arch Otorhinolaryngol 1998;255(8):396-401. google scholar
• 17. Martin AD, Harner SG. Ossicular reconstruction with titanium prosthesis. Laryngoscope 2004;114(1):61-4. google scholar
• 18. Baylancicek S, Iseri M, Topdağ DÖ, Ustundag E, Ozturk M, Polat S et al. Ossicular reconstruction for incus long-process defects: bone cement or partial ossicular replacement prosthesis. Otolaryngol Head Neck Surg 2014;151(3):468-72. google scholar