Ossicular reconstruction with titanium prosthesis

OBJECTIVES: To evaluate the results when using titanium total ossicular replacement prosthesis (TORP) or partial ossicular replacement prosthesis (PORP) in chronic ear disease. STUDY DESIGN: Retrospective chart review was performed. METHODS: Sixty-eight ossicular procedures using a titanium TORP (n = 30) or PORP (n = 38) were performed at a tertiary referral center between December 1999 and June 2002. The ossiculoplasty was performed either alone or in combination with other chronic ear surgery. Cartilage grafts were used universally. Nineteen percent were primary operations, and 6% were planned second stages. The majority were revision procedures. Follow-up ranged from 3 months to 2.5 years. RESULTS: The prosthesis is easy to insert, well tolerated, and has a low extrusion rate. Average air-bone gap (ABG) improvement was 13 dB with closure of the ABG to within 20 dB in 57% of cases. Hearing results were better for primary versus revision cases for PORPs versus TORPs and for intact canal wall (ICW) procedures versus canal wall-down (CWD) procedures. CONCLUSION: Titanium is a satisfactory material for use in ossicular reconstruction because of its ease of insertion, tissue tolerance, and low rate of extrusion. Caution is advised when selecting candidates for this procedure during revision surgery, especially if the canal wall and stapes superstructure are absent.     

Hearing results with the titanium ossicular replacement prostheses

The purpose was to study the hearing results in patients receiving a Kurz titanium Bell partial ossicular replacement prosthesis (PORP) or an Aerial total ossicular replacement prosthesis (TORP). The study was a retrospective chart review in a tertiary otologic referral center. A computerized otologic database was used to identify 111 patients implanted with either a PORP or TORP prosthesis. Audiograms were reviewed and air-bone gaps were calculated for each patient. The improvement of the average air-bone gap (ABG) was 10.2 and 12.7 dB at 3 and 20 months after ossiculoplasty, respectively. Sixty-six percent of patients (73/111) had a postoperative air-bone gap of 20 dB or less. The ABG for the titanium PORP prosthesis was 14.3±9.7 dB, compared with 25.2±13.7 dB for the TORP prosthesis ( P <0.05). The ABG to within 20 dB or less was obtained in the PORP group in 77% of the cases, versus 52% of the cases in the TORP group ( P <0.05). Two extrusions of the prostheses were observed at 17 and 20 months after surgery (1.8%). Revision procedures for functional failure were carried out in 20 patients (18%). The rate of sensorineural hearing loss was 3.6%. The major factors influencing good audiometric results were the surgical procedure preserving the external auditory canal and the presence of the stapes. The best hearing results were achieved when a PORP was used in an intact canal wall (ICW) procedure, and the worst hearing results were achieved when a TORP was used in a canal wall down (CWD) procedure. The titanium Kurz prosthesis has been an effective implant at our institution for ossicular reconstruction.     

乳突切开术并一期听骨链重建的临床疗效分析

目的：评估乳突切开术并一期行听骨链重建的临床疗效。方法：对2008-01～2011-06期间在我科住院行乳突切开术并一期钛人工听骨植入手术并且有完整随访资料的患者139例进行回顾分析,其中置入部分听骨赝复物（PORP）者91例,置入全听骨赝复物（TORP）者48例,随访时间为2～5年,纯音测听法（PTA）检测患者术前及术后听力,比较手术前后的气导听阈（0．5、1．0、2．0、4．0kHz四个频率气导之平均值）及气骨导差（ABG）,分析钛人工听骨在同期听骨链重建术的听力重建效果。术后ABG≤20dB为听力提高有效。结果：PORP植入患者术前气导平均听阈为（53．97±11．32）dB,术后为（36．80土11．68）dB,平均降低（17．17±5．79）dB;术前ABG平均为（31．84±6．17）dB,术后为（15．13±7．22）dB,平均缩小（16．71±5．50）dB;TORP组患者术前气导平均听阈为（58．05±11．35）dB,术后为（44．53±13．15）dB,平均降低（13．52±7．81）dB;术前ABG平均为（35．67±5．73）dB,术后为（21．48±7．01）dB,平均缩小（14．18±7．53）dB;各组术前术后的差异均有统计学意义（P〈O．01）。PORP组术后ABG≤20dB者（术后听力提高有效）共68例,有效率为74．73％;TORP组术后ABG≤20dB者共26例,有效率为54．13％;总有效率为68．63％,两组之间的差异有统计学意义（P＜0．05）。结论：乳突切开术并同期钛人工听骨植入取得了良好的听力效果,PORP比TORP的听力改善效果好。     

Ossiculoplasty with the use of autografts and synthetic prosthetic materials: a comparison of results in 165 cases.

One hundred and sixty-five cases of different kind of ossiculoplasty in patients suffering from chronic middle ear disease were performed at the ENT department of Papanikolaou Hospital in Thessaloniki, Greece, during the years 1988-1990. There were 40 cases of incus transposition, 47 cases in which polyethylene TORPs and PORPs were used and 77 cases of hydroxylapatite prostheses (41 TORPs and 37 double notch PORPs). Hearing success was defined as a post-operative air-bone gap of < 20 dB. According to this criterion 74 per cent of the incus transposition cases were successful, 61 per cent of the polyethylene TORPs, 65 per cent of the hydroxylapatite TORPs, 40 per cent of the polyethylene TORPs, and 89 per cent of the double notch hydroxylapatite PORPs. It is obvious that ceramic PORPs produced the best results, while there was no statistical difference, regarding the hearing improvement, among the different kinds of TORPs which were used. Extrusion rate and other kinds of complications are also discussed, as well as a case of severely damaged ceramic TORP, within two years due to middle ear infection.     

Ossicular chain reconstruction: the TORP and PORP in chronic ear disease

The traditional objectives of tympanoplasty are infection control, closure of the ear by grafting techniques, and hearing rehabilitation via ossicular reconstruction. The multiplicity of contemporary prostheses and surgical options available would seem to underscore the magnitude of the ossicular reconstruction problem in the difficult chronic ear relative to all else. The success of stapedectomy has led to great expectations for all problems of ossicular reconstruction. The circumstances of the chronic ear is a milieu hostile in comparison and precludes any such comparison. Multiple sites of ossicular pathology, variations in mucosa health, inconsistent middle ear aeration and the overall complexity of the chronic ear present the otologist with a physiodynamic problem the solution of which is far from simplistic. The TORP and PORP have been enthusiastically endorsed in this regard, as a very suitable answer. Such enthusiasm, however, has been largely derived from data accumulated in the short term, often in less than a year's follow-up. This report reviews the authors' results in 141 patients in whom 86 TORPs and 55 PORPs were employed. For comparison, hearing data in 276 ears in which the fitted incus prosthesis, the authors' preferred reconstruction format, was used. Success for TORP reconstruction was assessed as air-bone gap closure to within 30 dB and for PORP, to within 20 dB. This was accomplished in 85% and 49% respectively. Extrusion rate, overall, was 10%. Relative advantages and disadvantages of the TORP and PORP are discussed and serve as a basis for the decision to continue to use this method of ossicular reconstruction. This data is put into perspective in acknowledging that the TORP and PORP are not the ultimate solution to this problem. When employed in combination with newer techniques in cartilage tympanoplasty, further improvement is expectant.     

Closed tympanoplasty in cholesteatoma surgery: long-term (10 years) hearing results using cartilage ossiculoplasty

The aim of this retrospective study was to evaluate the long-term hearing results of using costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for a middle ear cholesteatoma with an intact canal wall tympanoplasty. Thirty-six patients (four with bilateral disease) followed up for 10 years who underwent an ossiculoplasty with a cartilage prostheses between January 1987 and December 1989 constituted the population studied. All the subjects underwent a staged intact canal wall tympanoplasty with mastoidectomy. Ossiculoplasty with total or partial chondroprosthesis was performed during the second stage. The long-term outcome was evaluated in terms of hearing according to the guidelines of the Committee on Hearing and Equilibrium (1995), and in terms of complications (anatomical and functional). In 18 patients a partial cartilage ossicular replacement prosthesis (PORP) was used, while in 22 a total cartilage ossicular replacement prosthesis (TORP) was used. In the PORP group the mean preoperative air–bone gap (ABG) was 22.4 dB hearing level (HL); before the second stage the ABG was 37.9 dB HL, at 2 years it was 12.1 dB HL, at 5 years 15.3 dB HL and at 10 years 15.8 dB HL. In the TORP group the mean preoperative ABG was 31.6 dB HL; before the second stage the ABG was 41.1 dB HL, at 2 years it was 14.4 dB HL, at 5 years 17 dB HL and at 10 years 18.5 dB HL. In both groups the number of cases with a postoperative ABG of < 20 dB HL remained stable (P > 0.05) over time. The failure rate was 17.5%, but only in 5% of cases was a functional revision needed. No cases of extrusion of the prostheses were encountered. The use of a chondroprosthesis is associated with functional results similar to those obtained by other authors. The efficacy of the prostheses remains stable over time and is associated with a very low rate of complications and failures. In this series no extrusion occurred and in no case did an infectious disease develop after cartilage transplantation. Received: 7 August 2000 / Accepted: 2 November 2000     

A comparison of PORP, TORP, and incus homograft for ossicular reconstruction in chronic ear surgery

This report presents the results of 210 cases over a 10-year period using PORPs, TORPs, and notched incus homografts (NIH), for ossicular reconstruction in chronic ear surgery. There were 192 adults and 18 children. The surgical technique utilized temporalis fascia in an underlay technique with canal skin covering the outer surface of the fascia. Intact canal wall mastoid-tympanoplasty, as a one-stage procedure, was used for most cases. Homograft nasal cartilage was placed between the Plasti-Pore prosthesis and the graft. Notched incus homografts were prepared prior to surgery and stored in 4% formalin. There were 149 mastoid-tympanoplasties and 61 tympanoplasties performed. Revision of our cases was performed in 16.6%. Within 3 months of surgery, 86% of adults, and 44% (8/18) of children had dry, healed ears free of disease. The graft take rate was 96%. In adults, a total of 99 NIH, 50 TORPs, and 43 PORPs were implanted. In adults, the closure of the air-bone gap to 20 dB or less occurred in 58% using TORPs, 67% using PORPs, 76% using NIH-Partial replacement, and 20% using NIH-Total replacement. Excluding the cases that failed for reasons other than conductive hearing loss, the results improved to 69% for TORPs, 77% for PORPs, 77% for NIH-P, and 27% for NIH-T. In adults, the extrusion rate was 5.5% for Plasti-Pore and 3% for NIH. In children, the extrusion rate was 17% for Plasti-Pore prostheses. From this study, it appears that PORPs and TORPs with homograft nasal cartilage are satisfactory prostheses for chronic ear surgery in adults. In children, Plasti-Pore prostheses should be avoided unless the ear is healed, aerated, and stable. NIHs are good prostheses when the stapes is intact, but they are inferior to the TORP when placed on the footplate. Also, the NIH requires preparation prior to surgery and may be difficult to obtain. We plan to continue using PORPs and TORPs in chronic ear surgery until a better technique is found, or the complication rate becomes unacceptable.     

Hearing results in pediatric patients with chronic otitis media after ossicular reconstruction with partial ossicular replacement prostheses and total ossicular replacement prostheses

OBJECTIVE: To examine hearing results in pediatric patients after ossicular reconstruction with partial ossicular replacement prostheses (PORPs) and total ossicular replacement prostheses (TORPs) in children with chronic otitis media. METHODS: A retrospective chart review was performed on 55 pediatric patients with chronic otitis media who underwent ossicular reconstruction from 1991 to 1998. Patients' audiograms were evaluated preoperatively and postoperatively for pure-tone average (PTA), air-bone gap (ABG), speech reception threshold (SRT), method of ossicular reconstruction, and management of the mastoid. RESULTS: Twenty-seven patients underwent ossicular reconstruction with TORPs. The average preoperative ABG was 40.1 dB, and the average postoperative ABG was 31.6 dB. Forty-one percent of the children improved their PTA greater than 10 dB postoperatively, and 52% of children did not change their ABG by more than 10 dB postoperatively. Nineteen percent of children with TORPs had a postoperative ABG less than 20 dB, and 44% of children with TORPs had a postoperative ABG less than 30 dB. Twenty-eight patients underwent ossicular reconstruction with PORPs. The average preoperative ABG was 29.7 dB, and the average postoperative ABG was 22.5 dB. Thirty-two percent of patients improved their PTA by greater than 10 dB, while 57% of children with PORPs did not change their ABG by more than 10 dB postoperatively. Forty-three percent of children with PORPs had an ABG of less than 20 dB postoperatively, and 71% of children with PORPs had a postoperative ABG less than or equal to 30 dB. CONCLUSIONS: Children who underwent ossicular reconstruction with PORPs had slightly better postoperative hearing than did children with TORPs. Postoperative hearing was essentially unchanged in approximately 55% of both groups. Preoperative hearing levels may be the most important factor determining postoperative hearing in nonstaged surgery for children with chronic otitis media Long-term hearing results in children with single-stage surgery were not as good as those reported in the literature for staged surgery. Severe mucosal disease and eustachian tube dysfunction may contribute to poorer hearing results in children.     

Hydroxylapatite ossicular replacement prostheses: results in 157 consecutive cases.

The use of hydroxylapatite for ossicular chain reconstruction is increasing. In this study, hearing results and extrusion rate for 157 consecutive patients receiving hydroxylapatite prostheses were evaluated. Results were compared to those of a control group of patients who had received either homograft bone or Plasti-Pore prostheses. Four (2.6%) cases of extrusion have occurred. Hearing success was defined as a postoperative puretone average air-bone gap of < or = 15 dB for incus prostheses and partial ossicular replacement prostheses (PORPs) or < or = 25 dB for incus-stapes prostheses and total ossicular reconstruction prostheses (TORPs). Overall success rate in the hydroxylapatite group was 51.4% for the 140 patients with postoperative data (mean follow-up, 11.5 months) and 46.7% for 90 patients who were followed for more than 6 months (mean follow-up, 16 months). PORP results were significantly poorer than those of the other prostheses. The success rate for the control group was 58.6% for 58 patients. The difference between hydroxylapatite and control group success rates appears to be due to the poorer results of the hydroxylapatite PORP.     

Six years experience of Plastipore

A 6 year personal experience in the performance of Plastipore prostheses in middle ear reconstruction is presented. The good hearing results at 12 months are not maintained with TORPs or PORPs and 41.6% have been rejected. Better results are obtained with a tube prosthesis between a mobile malleus and stapes. The use of TORP and PORP has now been abandoned in favour of ossicles or homograft cartilage.     

Audiological results of endoscopic surgical repair of the long process of incus

ObjectiveThe purpose of this study is to evaluate our experience with endoscopic repair of ossicular discontinuity at the incudostapedial joint, with or without an intact stapes suprastructure, and present our hearing results. We classify results based on the causative pathology, the type of ossiculoplasty, and type of lesion. We demonstrate the ability to endoscopically place a total ossicular replacement prosthesis (TORP), measuring 4.25 mm, between the stapes footplate and the incus remnant to reestablish ossicular continuity.MethodsThis was a retrospective case series conducted in tertiary referral center (Hopital de la Timone) Marseille, France. 25 patients underwent incudostapedial rebridging ossiculoplasty between 2009 and 2013. Fifteen cases of chronic otitis media and 10 otosclerosis revisions were included in the study. Three different materials were used in ossiculoplasty, hydroxyapatite cement, incus remnant, and partial/total ossicular replacement prostheses. Audiometric results were evaluated before and after ossiculoplasty. Twelve month follow-up data is provided.ResultsThe mean postoperative air-bone gap was 15 dB (5–25 dB). Hearing results were better inotosclerosis revisions. Hydroxyapatite cement produced an air-bone gap of 5 dB, TORP placed under the incus produced a 12 dB gap, and TORP placed under the malleus resulted in a 12 dB gap and one deaf ear. In cases of chronic otitis media, the residual air-bone gap was 17 dB with PORP, 12 dB with TORP, and 20 dB with incus transposition.ConclusionThe hydroxyapatite cement is effective in the reconstruction of ossicular discontinuity but the high price limits its utilization. TORP placed under the incus is a reliable and stable method of ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.     

Autologous fitted incus versus Plastipore PORP in ossicular chain reconstruction

Hearing results and causes of failure with three types of ossicular reconstruction techniques over an intact stapes, during second-stage intact canal wall tympanoplasty, are reported herein. The three types of reconstruction are: fitted autologous incus (38 cases); Plastipore PORP with cartilage (41 cases); Plastipore PORP without cartilage (32 cases). A residual air-bone gap within 15 dB. was found in 63.2 per cent of fitted includes, in 41.5 per cent of PORPs with cartilage, and in only 37 per cent of PORPs without cartilage. Eighty-four per cent fitted incudes, 63 per cent PORPs with cartilage and 44 per cent PORPs without cartilage yielded a residual air-bone gap within 25 dB. Extrusion has been the main cause of failure among Plastipore prostheses.     

Tympanoplasty with hybrid prostheses

BACKGROUND: The retrospective study reviews the hearing results of partial and total ossicular replacement plasties with prostheses composed of a hydroxylapatite head and a trimmable shaft. PATIENTS AND METHODS: 71 patients underwent tympanoplasty type III between January 1996 and January 2002. The partial (PORP) (55 patients) and total ossicular replacement prostheses (TORP) (16 patients) were a composition of a hydroxylapatite head and a trimmable hydroxylapatite-polyethylene composite shaft (HAPEX ). Hearing results were evaluated according to the guidelines of the Committee on Hearing and Equilibrium. RESULTS: In cases with a PORP the residual air-bone gap could be reduced to < or = 20 dB in 73% of the patients. The mean air-bone gap improved from 28 dB preoperatively to 17 dB postoperatively. In cases with a TORP the residual air-bone gap could be reduced to < or = 20 dB in 62% of the patients. The mean air-bone gap improved from 32 dB preoperatively to 20 dB postoperatively. CONCLUSIONS: The hearing results with prostheses composed of a hydroxylapatite head and a trimmable shaft are good and comparable to the results of authors using other synthetic ossicular prostheses. These prostheses are time-saving because the trimmable shaft can be quickly cut and shortened to an individual length.     

Ossiculoplasty with intact stapes: analysis of hearing results according to the middle ear risk index

Conclusions. In ossiculoplasty with intact stapes, using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses, improvement in hearing was nearly equal. In patients who had mild risk scores, the incus had better gain values compared with patients who had severe scores. Objective. We aimed to prove the utility of the middle ear risk index score and its predictive value in hearing outcome. We also evaluated hearing results for different reconstruction materials. Patients and methods. This was a retrospective chart review of 189 patients who had ossiculoplasty with intact stapes using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses. Hearing outcomes and the average improvement in hearing with different reconstruction materials were analysed by using middle ear risk index scores. Results. The average hearing improvements for incus, cortex and partial ossicular reconstruction prostheses were 12.77±14.58 (p<0.001), 12.34±15.98 (p=0.005) and 14.10±13.87 dB (p<0.001), respectively. The postoperative air–bone gap levels were 20.42±14.54 dB in incus, 17.33±16.86 dB in cortex and 17.59±11.66 dB in partial ossicular reconstruction prostheses. When the preoperative middle ear risk index scores and postoperative air–bone gap and gain values were compared, in the incus group, statistically significant associations were demonstrated between scores and hearing outcomes (p=0.009).     

同种肋软骨外耳道后壁及听力重建术

目的：消灭乳突根治术后遗留的开放乳突腔及外耳道后壁缺损。方法：采用同种异体肋软骨对乳突根治术后１７耳行外耳道后重建及乳突腔充填,同时Ⅰ期进行传音结构重建,其中部分听骨替换假体术式８耳,全听骨替换假体术式９耳。结果：经６个月￣２年随访,全部病一壁接近正常生理结构,完全成功１４耳,部分成功２耳,失败１耳,术后３个月鼓膜重新穿孔流脓。结论：以同种异体肋软骨对乳突根治术后耳行外耳道后壁及听力重建术,是防止     

Hydroxyapatite versus titanium ossiculoplasty.

OBJECTIVE: To compare the results of ossicular chain reconstruction using hydroxyapatite (HA) and titanium (TI) prostheses. STUDY DESIGN: Retrospective study and case series. SETTING: Tertiary referral center. PATIENTS: One hundred sixty-eight patients presenting chronic otitis media with or without cholesteatoma. INTERVENTION: Ossiculoplasty using partial or total HA and TI ossicular replacement prostheses (TORP and PORP, respectively). MAIN OUTCOME MEASURES: Patients were assessed at 2 months postoperatively to establish short-term results. Results of treatment for conductive hearing loss were reported according to guidelines. Available audiometric data at 1, 2, 3, and 5 years were used to assess prosthesis stability. Average postoperative air-conduction gain, air-bone gap, and sensorineural hearing level were measured at four frequencies: 0.5, 1, 2, and 4 kHz. Statistical analyses compared outcomes for HA TORP versus TI TORP and HA PORP versus TI PORP. RESULTS: Postoperative air-bone gap of less than 20 dB was obtained in 50% of HA TORP versus 45.8% of TI TORP cases and in 63.2% of HA PORP versus 72% of TI PORP cases. Preoperative middle ear status and presence/absence of malleus significantly influenced postoperative audiometric results. All types of prosthesis demonstrated significant postoperative air-conduction gain decrease on follow-up. Prosthesis exclusion was observed in three cases (1.78%). CONCLUSION: Prostheses using both types of biomaterial gave good functional results and stability with low exclusion rates, with no statistically significant differences between the two. Trends could be observed for slightly better results for HA in total reconstruction and for TI in partial reconstruction. The degradation in postoperative functional gain seemed to be independent of prosthesis type.     

Ossicular reconstruction: Incus versus universal titanium prosthesis

Objectives

The main purpose of this study is to compare audiological outcomes of incus reconstruction, Xomed Medtronic universal titanium partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP). We also compared results based on surgical technique, history of previous surgery, form of the prosthesis head, pathology and frequency.

Methods

A chart review was performed and included reconstructions performed between June 2003 and December 2006. Results were based on air–bone gap and pure tone average.

Results

Postoperative mean air–bone gap and mean pure tone average are significantly lower using incus reconstruction compared with the titanium prosthesis groups. PORP and TORP groups yielded similar outcomes. Closure of ABG is similar in all three groups. Postoperative results were better using an intact canal wall mastoidectomy compared with a canal wall down technique, but ABG closure was similar in both groups. Primary surgeries gave better results than revisions of reconstructions performed by the senior author or elsewhere.

Conclusion

Though Xomed Medtronic titanium prostheses are effective in ossicular reconstruction, incus reconstruction is at least as effective when feasible. Canal wall down mastoidectomy should be reserved for cases where preservation of the canal wall is contraindicated. Previous same ear surgery is a poor prognostic factor for successful outcome. Preliminary results indicate that round head PORPs may be superior to their oval head counterparts.     

新型HA-BMP复合人工听小骨临床应用观察

目的：对一种新型HA-BMP复合人工听小骨临床应用的效果进行评价。方法：对2000-2005年进行鼓室成形术的59例（61耳）患者进行随访。使用HA-BMP复合人工听小骨行鼓室成形术的26耳,其中全听骨赝复物7耳,部分听骨赝复物19耳;使用自体残余听骨重建者18耳;单纯大鼓室Ⅲ型手术17耳。结果：平均随访时间31.2个月;使用新型HA-BMP复合人工听小骨者的听力提高明显优于使用自体组织重建听骨链和单纯大鼓室Ⅲ型手术患者（均P〈0.01）,结果按照术后平均语频气骨导差小于20 dB为成功标准,HA-BMP复合人工听小骨组成功率为92.3%,随访均未见听骨脱出。结论：新型HA-BMP复合人工听小骨具有良好的生物相容性和优异的传音性能,明显优于自体组织,临床应用效果稳定,具有广泛的应用前景。     

Reconstruction of the entire ossicular conduction mechanism

OBJECTIVES/HYPOTHESIS: Stapes fixation combined with fixation, absence, or malformation of the malleus-incus complex requires an uncommon surgical reconstruction and offers a unique combination of challenges and hazards. This situation may occur in the presence of severe tympanosclerosis, otosclerosis, congenital ossicular malformations, and revision surgery for either stapedectomy or chronic ear disease. In previous reports, this procedure has been grouped with total ossicular reconstruction without much distinction. However, the challenges unique to this problem deserve special consideration. The present report offers a treatment plan for a group of patients requiring reconstruction of the entire ossicular conduction mechanism including removal of the stapes footplate. STUDY DESIGN: Retrospective review. METHODS: Three thousand three hundred fifty (3350) charts of patients requiring total ossicular replacement prostheses (TORPs) were reviewed. Of this group of patients, only 21 of 3350 patients from 1977 to 1999 required TORP placement and removal of the stapes footplate. The patients were followed for an average period of 50 months. RESULTS: Hearing results indicated an overall improvement in the air-bone gap of 10 dB, with 52% achieving an air-bone gap of less than 20 dB. Of the 21 cases, 5 revision surgeries were performed. Three were performed because of a displaced TORP (14.2%). and 2 were performed because of extruded TORPs (9.5%). CONCLUSIONS: Reconstruction of the entire ossicular conduction mechanism including removal of the stapes footplate can be successfully achieved with improvement of the air-bone gap of less than 20 dB. Hearing results and extrusion rates are comparable to reported results of TORP placement on a mobile footplate. Successful stapedectomy and simultaneous ossicular chain reconstruction can be performed as a single or staged procedure. Special attention is paid to avoid intrusion of the prosthesis into the vestibule.