Postinflammatory ossicular fixation in tympanoplasty

Postinflammatory ossicular fixation in chronic ear surgery is a common problem faced by the otologic surgeon. This thesis presents a review of the evolution of the three forms of postinflammatory ossicular fixation. The surgical techniques used to correct ossicular fixation are discussed. A detailed evaluation of 311 patients diagnosed as having clinical tympanosclerosis is presented.     

Bony ossicular fixation using 2-cyano-butyl-acrylate adhesive

We investigated the effects of 2-cyano-butyl-acrylate (Histoacryl) on the ossicles of 11 of 12 adult guinea pigs. A small amount of the adhesive, placed precisely between the incus and its bony fossa in each middle ear, fixed the ossicles. Light microscopic investigation of the ears of animals killed at 3, 6, 9, and 12 months after surgery showed a bony union of the ossicle to its surrounding niche in 11 of 12 operated-on ears. Negligible inflammatory reaction was seen in areas of the middle ear not in contact with the adhesive. These observations suggest that 2-cyano-butyl-acrylate may be used to achieve a durable bony union in ossiculoplastic surgery with minimal side effects in the middle ear.     

Epitympanic malleus fixation: Correction without disrupting the ossicular chain

The preoperative diagnosis of malleus fixation can be made consistently with a pneumatic otoscope. Nontympanosclerotic epitympanic malleus fixation, for the most part, has been corrected by disrupting the ossicular chain and then reconstructing the sound-conducting mechanism. Once the diagnosis of malleus fixation is established, the surgical approach should be modified to cope with the fixed malleus. A wide, inferiorly based tympanotomy flap affords ample access to the epitympanum and permits definitive resolution of the associated conductive hearing loss. Atticotomy and discreet osteotomy can free the fixed malleus and preserve continuity of the ossicular chain in over 90 percent of the patients with this syndrome. Experience for 46 patients having bony epitympanic malleus fixation, both congenital and acquired, was examined in concluding that the anatomical continuity of the ossicular chain can and should be maintained in most patients. The residual air-bone gap is less with an intact, though modified, ossicular chain than it is with a chain that has been reconstructed.     

Plastipore total ossicular replacement prosthesis.

In those ears in which the incus and/or malleus are missing or not suitable, a columella made of high density polyethylene sponge has proven to be very effective. Tissue readily grows into the large pores of this material so that it is well tolerated in the body. During the last six months 54 have been implanted with no rejection so far and a good hearing gain in 43 or 80 percent.     

Plastipore ossicular prostheses. A histological evaluation

The histological findings of 43 Plastipore ossicular prostheses (26 TORPs and 17 PORPs) removed during revision tympanoplasty are described and discussed.     

The N.I.F. classification of ossicular disorders

The authors present their classification of ossicular disorders. It is felt to be easy to use, and self-explanatory, and it lends itself conveniently to analysis of data by computer. Examples are shown of its use in analyzing data in relationship to the ossicular status, in quantifying the effects of different ossicular situations, and in comparing our results with those of other authors. Using the N.I.F. classification, these factors are surprisingly easy to manipulate. It is hoped that this classification will be of use to others engaged in the same type of studies.     

人工听骨在鼓室成形术中的应用

目的评价人工听骨在鼓室成形手术中的应用效果。方法对解放军总医院耳鼻咽喉头颈外科2004年9月至2006年4月施行的中耳炎手术中，接受人工听骨部分赝复物——多孔聚乙烯听骨赝复物（Partialossicularreplacementprostheses，PORP，美国美敦力公司）植入进行听骨链重建的患者42例进行随访。对随访半年以上、资料完整的38例（38耳）进行回顾性总结，应用SPSS统计软件进行疗效分析。计算语言频率（0．5，1，2kHz）气导平均听力及气骨导差，比较不同手术方式和PORP植入方式对疗效的影响。结果38耳鼓膜修补后1个月复查均愈合良好，但术后3个月时发现2例听骨脱出（均为术中人工听骨表面未置软骨片者）。38耳术前气导听力33．75～68．5dBHL，平均为（56．82±13．64）dB；骨导听力0～47．5dB，平均为（20．217±12．099）dB；术后气导听力平均为（34．23±15．04）dB，与术前相比t=3．682，P〈0．01。术前气骨导差（ABG）16．25～62．5dB，平均（36．625＋12．189）dB，其中21-30dB的9耳，〉30dB的24耳。术后ABG平均为（21．064±12．243）dB，与术前相比较，t=5．552，P〈0．01。其中术后ABG差≤20dB的19耳，20～30dB的9耳，〉30dB的8耳。术后ABG≤20dB者及ABG较术前缩小15dB者（术后听力提高有效）共28耳，总有效率为76-3％。结论PORP是一种可在听骨链重建中推广的人工听骨材料，术后取得良好的听力效果，但应注意避免术后听骨脱出。     

The embedding of ossicular chain specimens in plastic.

The following objects were specifically designed for teaching material to the medical students. Dried human auditory ossicles were bleached in 30% hydrogen peroxide solution and then, embedded in a good quality plastic. The plastic mass was shaped into a ball 5 cm in diameter, and the surface of which was polished with a good finish. The merits of the objects may be listed as follows; 1) A permenant preservation of the objects is possible because they are embedded in heat- and chemical-resistant material. 2) The objects are handy for use in the lecture room and easily observed by the students because of the magnifying effect of the plastic covering.     

Experience with a polyethylene total ossicular replacement prosthesis.

Surgical reconstruction of ossicular defects in chronic middle ear disease is a difficult problem. We have reviewed our results with the use of the Plastipore total ossicular replacement prosthesis (TORP). Of 29 procedures that were analyzed, nine were considered successful. None of our patients had a stapes superstructure, and 13 had no malleus. Placement of the TORP under the malleus handle and use of extra tissue between the prosthesis and the tympanic membrane provided better hearing results, but extrusion of the prothesis still occurred. Positioning of the prosthesis and contraction of the middle ear space, which causes extrusion of the prosthesis, remain problems in this type of reconstruction.     

Isolated congenital ossicular anomalies

Conclusions: Isolated congenital ossicular anomalies are diverse. Our proposed modified Teunissen and Cremers classification will be helpful for the evaluation of congenital ossicular anomalies as well as the prediction of surgical outcome. Objectives: The aim of this study was to describe isolated congenital ossicular anomalies encountered in patients who have normal eardrums and to evaluate their surgical outcome based on their classification. Patients and methods: A total of 78 patients (94 ears) with congenital ossicular anomalies were reviewed. The preoperative and postoperative audiological findings, surgical findings, and temporal bone CT results were analyzed. Results: Twenty-one types of ossicular anomalies were identified in this study. A stapes footplate fixation was the most common anomaly and this was usually bilateral. However, the anomalies that were associated with the incus and malleus were usually unilateral. The congenital ossicular anomalies were classified into five types according to the status of the stapes footplate. Using this modification of a prior classification system, the more severe anomalies of the stapes footplate could be identified, and the worst postoperative hearing result could be predicted.