Comparison of Autologous Malleus Head and Hydroxyapatite Partial Replacement Prosthesis in Ossicular Chain Reconstruction
Öz
ossicular
replacement prosthesis in ossiculoplasty. Data on the use
of the head of the malleus for partial ossicular reconstruction
is quite limited in the literature. The main objective of our
study is to compare the functional and anatomic outcomes
of ossiculoplasty using an autograft head of the malleus and
hydroxyapatite partial ossicular replacement prosthesis (HAPORP)
in Austin-Kartush type A ossicular chain defect.
Material and Methods: Patients who underwent surgery due
to attic cholesteatoma and had Austin-Kartush type A ossicular
chain defect (with intact and mobile stapes, no incus, or
not used as an autograft in ossiculoplasty) were included in the
study. The patients were divided into two groups according to
the material used for ossiculoplasty: those with malleus head
(Group I) and those with HA-PORP (Group II). The groups
were compared in terms of hearing gains obtained from the
results of pre-and post-operative hearing tests, prosthesis extrusion
rates, and recurrent cholesteatoma development rates.
Results: Postoperative air-bone gap (ABG) values were significantly
lower in group I. Postoperative ABG gains were also
significantly higher in group I. Functional success rates (postoperative
ABG ≤20 dB) were higher in Group I (65%) than in
Group II (50%), but the difference was not significant. Prosthesis
extrusion rates were significantly higher in Group II; there
were no differences between the groups in terms of recurrent
cholesteatoma.
Discussion and Conclusion: When the incus is not available
for ossiculoplasty, the head of the malleus can be considered as
the first choice because it is biocompatible, cost-free, and has
low extrusion rates compared with HA-PORP.
Anahtar Kelimeler
hydroxyapatite, ossicular replacement prostheses, ossiculoplasty, PORP
Kaynakça
- 1. Órfão T, Júlio S, Ramos JF, Dias CC, Silveira H, Santos M. Audiometric Outcome Comparison between Titanium Prosthesis and Molded Autologous Material. Otolaryngol Head Neck Surg. 2014 Aug;151(2):315-20. doi: 10.1177/0194599814533074.
- 2. Celenk F, Baglam T, Baysal E, Durucu C, Karatas ZA, Mumbuc S, et al. Management of incus long process defects: incus interposition versus incudostapedial rebridging with bone cement. J Laryngol Otol. 2013 Sep;127(9):842-7. doi: 10.1017/S0022215113001928.
- 3. Iurato S, Marioni G, Onofri M. Hearing results of ossiculoplasty in Austin-Kartush group A patients. Otol Neurotol. 2001 Mar;22(2):140-4. doi:10.1097/00129492-200103000-00004. PMID: 11300259.
- 4. Kumar S, Yadav K, Ojha T, Sharma A, Singhal A, Gakhar S. To Evaluate and Compare the Result of Ossiculoplasty Using Different Types of Graft Materials and Prosthesis in Cases of Ossicular Discontinuity in Chronic Suppurative Otitis Media Cases. Indian J Otolaryngol Head Neck Surg. 2018 Mar;70(1):15-21. doi: 10.1007/s12070-017-1184-4. Epub 2017 Sep 7.
- 5. 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 I. Otolaryngol Head Neck Surg. 1995;113: 186–187.
- 6. Fayad JN, Ursick J, Brackmann DE, Friedman RA. Total ossiculoplasty: short- and long-term results using a titanium prosthesis with footplate shoe. Otol Neurotol. 2014;35:108–113.
- 7. Fong JC, Michael P, Raut V. Titanium versus autograft ossiculoplasty. Acta Otolaryngol. 2010;130:554–558.
- 8. Preciado, D. A. Biology of cholesteatoma: Special considerations in pediatric patients. International Journal of Pediatric Otorhinolaryngology. 2012;76(3):319–321. doi: 10.1016/j.ijporl.2011.12.014.
- 9. Roux A, Bakhos D, Lescanne E, Cottier JP, Robier A. Canal wall reconstruction in cholesteatoma surgeries: rate of residual. Eur Arch Otorhinolaryngol. 2015 Oct;272(10):2791-7. doi: 10.1007/s00405-014-3280-3.
- 10. Emir H, Kizilkaya Kaptan Z, Göcmen H, Uzunkulaoglu H, Tuzuner A, Bayiz U, et al. Ossiculoplasty with intact stapes: analysis of hearing results according to the middle ear risk index. Acta Otolaryngol. 2009 Oct;129(10):1088-94. doi: 10.1080/00016480802587853.