In this study, we attempted to investigate and evaluate the efficacy of titanium PORPs, in particular the Kurz TTP-Variac System, in middle ear reconstruction. Although a variety of studies concerning this topic have already been published, comparison of the results in the literature is problematic because of the lack of a universally accepted protocol for reporting results after ossicular reconstruction.13 Moreover, several studies include results of both partial (PORP) and total (TORP) ossicular reconstruction without making a distinction between these 2 subgroups.8,10,14- 17 Other studies are multicentric, lacking surgical uniformity.8 Finally, in some publications, different types of titanium PORPs were used.8,15 Direct comparison between published series is further thwarted because all required parameters for statistical analysis are rarely reported.2,4,8,10,17,18 In Table 2, our postoperative results are compared with other published results. The type of prosthesis used is indicated in the table. To our knowledge, our series of 89 patients is the largest single-center study in which the Kurz TTP-Variac System PORP is used by the same surgeon for reconstruction of the ossicular chain. We observed a mean postoperative PTA ABG of 15.58 dB, a mean PTA ABG improvement of 10.62 dB, and a success rate of 73%. Mean follow-up time was 13 months, and results proved to be stable during the follow-up. As shown in Figure 2B, the postoperative ABG on 4 kHz tended to be more pronounced compared with lower frequencies, a finding that is also observed by Schmerber et al17 and that can be attributed to prosthesis design. In a study on the effect of prosthesis design on vibration of the reconstructed ossicular chain, Kelly et al19 suggest that a prosthesis should be as light as possible and sufficiently rigid for improved high-frequency transmission. Compared with other materials such as gold or ceramics, titanium is lighter and stiffer, yielding superior results on high frequencies.4 With respect to earlier published results, summarized in Table 2, direct comparison of our own mean postoperative PTA ABG was only possible with 4 studies5,14- 16 because the required parameters for statistical comparison (eg, standard deviations) were lacking in the other series. Only the mean postoperative PTA ABG reported by Vassbotn et al14 proved to be significantly lower than ours and amounted to 9 dB (independent t test, P < .01). Regarding the PTA ABG improvement in the different studies, the results communicated by Vassbotn et al,14 Krueger et al,5 and Ho et al16 proved to be significantly higher than ours and amounted to 19.0, 19.4, and 20.6 dB, respectively (independent t test, P < .01). A comparison of the postoperative success rates of the studies mentioned in Table 2 reveals that only the study by Quaranta et al,10 which exclusively included cholesteatoma cases, showed a statistically significant lower success rate (χ2 test, P < .01). In all other studies, no significant differences in rates of postoperative successful hearing were observed (χ2 test, P = .16).4,5,8,14,16- 18 With the results of Quaranta et al10 excluded, the global success rate amounted to 75% (study success cross-tabulation).4,5,8,14,16- 18 However, a closer look at the aforementioned studies reveals some weaknesses. In the article by Vassbotn et al,14 the study population consists of 38 PORP and 35 TORP procedures. Mean follow-up time, underlying disease, proportion of revision cases, and complication rate are known only for the total (PORP + TORP) group and not for the PORP group in particular, which makes comparison with our group, which included a substantial proportion of cholesteatoma and revision cases, difficult. The results of the study by Krueger et al5 also have to be interpreted carefully because of the small population (16 ears) and the limited follow-up time (up to 12 months in only 4 of 16 ears). In the series by De Vos et al15 and Dalchow,8 several types of prostheses were used, decreasing the surgical uniformity. The results reported by Ho et al16 have to be interpreted with caution because of the small population (N = 14), the unknown follow-up time, and the use of a PORP that is not further specified. When the aforementioned results are taken into account, our mean ABG improvement is modest compared with those of other studies, whereas our success rates approximate the best results described in the literature. This can be explained by the relatively low preoperative ABGs in our groups with underlying chronic otitis media with and without cholesteatoma (24.41 and 25.06 dB, respectively). This illustrates our policy of performing surgery at an early stage before complete destruction of the ossicular chain has occurred (especially destruction of the stapes superstructure).