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.