T1 - Ossicular chain reconstruction

A CT scan is a form of X-Ray imaging which allows us to see the body in much clearer detail than plain X-Rays. The CT scan splits the image into thin layers, sliced like a salami, so that we can see much greater detail and pinpoint what is happening at any given point. It is only in recent years that scanners have been able to produce slices thin enough to give us useful information on the state of the middle ear. Some ear surgeons always require a CT scan before operating. In the days before CT scans, some ear surgeons always wanted mastoid X-rays before operating. I have never found them all that useful. Even with the best scanners, we don’t get anywhere near as good a view as we get with the operating microscope during surgery – full colour, three dimensional and up to 40 times magnification. It is impossible to tell with a scan whether some part of the ossicular chain is fixed – this can only be determined by trying to move it during surgery. Many of the patients referred to me for ear surgery have already had scans. They rarely make any difference to what I plan on doing. I do not need a scan as a matter of routine. A CT scan is needed if we suspect complications, especially if we suspect there may be spread of disease into the brain.

"Alternatives in Biocompatable Ossicular Implants." vol.

porous polyethylene partial ossicular replacement prosthesis ..

Other options include the insertion of a strut made out of an artificial bone, called hydroxy apatite. This artificial bone is porous and allows for the ingrowth of blood vessels and the complete assimilation of the artificial bone into the individual’s middle ear. With the modern day use of hydroxy apatite, there has been a marked reduction in the rejection of ossicular reconstruction prostheses.

A variety of prostheses may be used in ossicular reconstruction ..

Reconstruction of this type of ossicular discontinuity can be performed at the time of tympanoplasty surgery. There are several options. If the gap is small, it can be bridged by inserting a small piece of bone or cartilage taken from the patient at another site (behind the ear or from the lobe of tissue called the tragus in front of the ear). If there is a larger gap, then the incus bone is removed and modelled into a tooth-like prosthesis, using the operating microscope. This is then reinserted between the stapes and the malleus in order to reestablish continuity of the ossicular chain.

Picture of Ossicular chain reconstruction with PORP (Partial Ossicular Replacement Prosthesis)
CT evaluation of prosthetic ossicular reconstruction procedures: What the otologist needs to know

Surgical reconstruction of the ossicular chain is a well ..

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.

ENT Faculty Practice | Patient Information Westchester …

N2 - Objective: To compare the complication rate and hearing results of a new, lightweight, titanium ossicular replacement prosthesis with Plastipore prostheses (Xomed, Jacksonville, FL). Study Design: Retrospective. Methods: Charts were reviewed for type of operation, type of prosthesis used, extrusion rate, prostheses failure rate, and hearing thresholds at multiple frequencies and at multiple follow-up points. The dependant variable for hearing results was the four-frequency average air-bone gap. Results: There were 84 patients undergoing tympanoplasty with the Plastipore prosthesis and 53 with the titanium. There was one extrusion in the titanium group. There was an additional single incidence of prosthesis failure in the titanium group. Overall hearing results were comparable with an air-bone gap average of 19.3 dB in the Plastipore group compared with the titanium group with an air-bone gap of 22.0 dB (P = .08). Sixty percent of patients had a postoperative air-bone gap of 20 dB or less in the Plastipore group. In the titanium group, 45.3% achieved a 20 dB or less postoperative air-bone gap. Plastipore had a lower air-bone gap than the titanium when a canal wall up operation was performed (17.8 vs. 23.9 dB) and tended toward a lower air-bone gap when a total ossicular prosthesis was needed (22 vs. 27 dB) (P

Otology and Ear Surgery * ENT Surgical Consultants …

N2 - 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.