Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2009
Partial ossicular reconstruction: comparison of three different prostheses in clinical and experimental studies.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Neudert Marcus, Zahnert Thomas, Lasurashvili Nikoloz, Bornitz Matthias, Lavcheva Zlatina, Offergeld Christian
Аннотация
OBJECTIVE: To compare the reconstruction results of a long incus process defect using 3 different partial ossicular replacement prostheses (PORP).
STUDY DESIGN: Temporal bone experiments and retrospective case review.
SETTING: Tertiary referral center. EXPERIMENTAL MATERIAL AND PATIENTS: The experimental study was performed on 18 temporal bones; 66 patients with retraction pockets, chronic otitis media with or without cholesteatoma.
INTERVENTIONS: Ossiculoplasty using 3 different PORP: titanium angle prosthesis, autologous incus interposition, and titanium clip prosthesis.
MAIN OUTCOME MEASURES: Laser Doppler vibrometry in temporal bones measured transmission properties of the PORP. Patients were retrospectively assessed up to 5 years after surgery. Audiologic data were analyzed for preoperative and postoperative air conduction and air-bone gap at 0.5, 1, 2, 3, and 4 kHz. Statistical analyses compared the outcome in the experimental and clinical setting.
RESULTS: Experimentally, the titanium PORP showed similar transmission properties because the overall difference to the intact specimen was -4.14 +/- 0.59 dB for the titanium angle prosthesis and -4.61 +/- 0.57 dB for the titanium clip prosthesis. The transmission after an autologous incus interposition was significantly worse (-9.32 +/- 0.39 dB, p < or = 0.001) compared with the other prostheses. Patients' mean postoperative air-bone gap was 25.5 +/- 1.2 dB and less than 20 dB in at least 66% of cases without any significant differences between the groups.
CONCLUSION: In the clinical setting, the confounding factors that influence the acoustic outcome after partial ossiculoplasty obscure the prosthesis-related transmission factors that can otherwise be derived in the experimental setting. The results do not generally favor the use of 1 specific prosthesis, rather they suggest that the correct choice of a prosthesis be based on the anatomic and pathophysiologic conditions found in the individual patient.
STUDY DESIGN: Temporal bone experiments and retrospective case review.
SETTING: Tertiary referral center. EXPERIMENTAL MATERIAL AND PATIENTS: The experimental study was performed on 18 temporal bones; 66 patients with retraction pockets, chronic otitis media with or without cholesteatoma.
INTERVENTIONS: Ossiculoplasty using 3 different PORP: titanium angle prosthesis, autologous incus interposition, and titanium clip prosthesis.
MAIN OUTCOME MEASURES: Laser Doppler vibrometry in temporal bones measured transmission properties of the PORP. Patients were retrospectively assessed up to 5 years after surgery. Audiologic data were analyzed for preoperative and postoperative air conduction and air-bone gap at 0.5, 1, 2, 3, and 4 kHz. Statistical analyses compared the outcome in the experimental and clinical setting.
RESULTS: Experimentally, the titanium PORP showed similar transmission properties because the overall difference to the intact specimen was -4.14 +/- 0.59 dB for the titanium angle prosthesis and -4.61 +/- 0.57 dB for the titanium clip prosthesis. The transmission after an autologous incus interposition was significantly worse (-9.32 +/- 0.39 dB, p < or = 0.001) compared with the other prostheses. Patients' mean postoperative air-bone gap was 25.5 +/- 1.2 dB and less than 20 dB in at least 66% of cases without any significant differences between the groups.
CONCLUSION: In the clinical setting, the confounding factors that influence the acoustic outcome after partial ossiculoplasty obscure the prosthesis-related transmission factors that can otherwise be derived in the experimental setting. The results do not generally favor the use of 1 specific prosthesis, rather they suggest that the correct choice of a prosthesis be based on the anatomic and pathophysiologic conditions found in the individual patient.
Предметные рубрики MeSH
Acoustic StimulationAdultAudiometryAudiometry, Pure-ToneBone ConductionCholesteatomaData Interpretation, StatisticalEar OssiclesFemaleHumansMaleMiddle AgedOssicular ProsthesisOssicular ReplacementOtitis MediaOtologic Surgical ProceduresStapesTemporal BoneTreatment OutcomeTympanic Membrane PerforationTympanoplasty