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Original Investigation |

Long-term Results of the Cartilage Shoe Technique to Anchor a Titanium Total Ossicular Replacement Prosthesis on the Stapes Footplate After Type III Tympanoplasty ONLINE FIRST

Antoniu-Oreste Gostian, MD1; Jean-Marc Kouamé, DDS1; Martin Bremke, MD1; Magdalene Ortmann, PhD2; Karl-Bernd Hüttenbrink, MD1; Dirk Beutner, MD1
[+] Author Affiliations
1Department of Otorhinolaryngology–Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
2Jean-Uhrmacher-Institute for Clinical ENT-Research, University of Cologne, Cologne, Germany
JAMA Otolaryngol Head Neck Surg. Published online August 18, 2016. doi:10.1001/jamaoto.2016.2118
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Importance  Multiple techniques for a more secure and stable anchoring of the foot of a total ossicular replacement prosthesis (TORP) on the footplate have been proposed. To address this issue, a technique was developed that fits a cartilage shoe into the oval niche to guide the base of the prosthesis into a preformed central perforation.

Objective  To evaluate the long-term results of the cartilage shoe technique used to anchor a titanium TORP on the stapes footplate in patients after type III tympanoplasty.

Design, Setting, and Participants  Medical record review of total ossiculoplasties at a single center. The study included all patients who had undergone a tympanoplasty using a TORP between January 1, 2004, and December 31, 2008, at the Department of Otorhinolaryngology–Head and Neck Surgery, University of Cologne, Cologne, Germany.

Main Outcomes and Measures  Hearing thresholds were determined by a 4-frequency (500-4000 Hz) pure-tone average air-bone gap (PTA-ABG). Intraoperative findings from revision surgery and second-look operations are reported.

Results  Forty-two ears were eligible for follow-up examination, averaging 6.8 years (range, 4.8-9.1 years) after surgery, that comprised otoscopy and audiometry. The mean age of 22 women and 20 men was 42.8 years (age range, 6-78 years). The overall PTA-ABG decreased from a mean (SD) of 33.0 (8.4) decibels (dB) before surgery to a mean (SD) of 22.0 (10.1) dB after surgery (P ≤ .001, η = 0.402). Before surgery, 64% (27 of 42) of the patients had a PTA-ABG exceeding 30 dB, which was 30 dB or less in 76% (32 of 42) of the patients after surgery. After canal wall down (n = 18) and tympanoplasties with intact canal wall (n = 24), the PTA-ABG was reduced from a mean (SD) of 33.0 (8.9) dB to 24.6 (11.2) dB (P = .01, η = 0.271) and from a mean (SD) of 32.0 (7.3) dB to 19.6 (9.2) dB (P ≤ .001, η = 0.511), respectively. For transmeatal revision ossiculoplasty (n = 33), the PTA-ABG improved from a mean (SD) of 32.0 (8.6) dB to 21.0 (10.2) dB (P ≤ .001, η = 0.389), similar to primary ossiculoplasty (n = 9), with a mean (SD) of 33.0 (5.5) dB PTA-ABG before surgery and a mean (SD) of 21.0 (9.8) dB PTA-ABG after surgery (P = .005, η = 0.478). Intraoperative findings from revision surgery (n = 11) during the study period and second-look procedures (n = 7) showed that the cartilage shoe prevented a lift off the footplate in all but 2 patients, even in the presence of recurrent cholesteatoma.

Conclusions and Relevance  The use of the cartilage shoe that anchors a titanium TORP on the stapes footplate can be advocated for good and reliable long-term results after total ossiculoplasty.

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Figure 1.
Cartilage Shoe Holding the Base of the Total Ossicular Replacement Prosthesis Securely in the Oval Niche

Shown is the cartilage shoe in vivo 5 years after implantation. The arrow indicates the cartilage shoe holding the total ossicular replacement prosthesis.

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Figure 2.
Hearing Results of 42 Evaluated Ears in 42 Patients

A, Shown are the mean air conduction (AC) and bone conduction (BC) hearing thresholds of all 42 ears. B, Shown are the numbers of patients relative to their pure-tone average air-bone gap (PTA-ABG) before surgery, 3 weeks after surgery (early follow-up), and 6.8 years after surgery (late follow-up).

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