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OSSICULOPLASTY

OSSICULOPLASTY. Analysis of Results Dr.Jerry Halik MD FRCSC. N= 133 (Total-209) Age 5-71 Follow-up: up to 71 months(2 years average) . Applebaum Incus Replacement Prosthesis(small). N = 28 Average age: 41 years (18-67)

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OSSICULOPLASTY

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  1. OSSICULOPLASTY Analysis of Results Dr.Jerry Halik MD FRCSC

  2. N= 133 (Total-209) • Age 5-71 • Follow-up: up to 71 months(2 years average)

  3. Applebaum Incus Replacement Prosthesis(small) • N = 28 • Average age: 41 years (18-67) • Average follow-up: 20 months(1-76)

  4. Applebaum Incus Replacement Prosthesis(small)- Pre-op Diagnosis • Chronic Otitis Media : 25(89%) • Cholesteatoma : 2 • Trauma : 1

  5. Applebaum Incus Replacement Prosthesis(small)-Types of Repair • Ossiculoplasty:12(43%) • Ossiculoplasty with Tympanoplasty :14(50%) • With canal wall down Mastoidectomy and Tympanoplasty:2 (7%)

  6. Applebaum Incus Replacement Prosthesis(small)-ResultsA-B closurePossible SRT<30 db:23 post op SRT <30dB:15/23(65%)

  7. Wehr’s 2.7mm Incus Replacement Prosthesis • N=29 • Average age:40 years(12-67) • Average follow-up:19 months(1-77)

  8. Wehr’s 2.7mm Incus Replacement Prosthesis-Pre-op Diagnosis • Chronic Otitis Media: 15 (52%) • Cholesteatoma: 9 (31%) • Malleus Head Fixation : 5(17%)

  9. Wehr’s 2.7mm Incus Replacement Prosthesis- Types of Repair • Ossiculoplasty:12 (41%) • Ossiculoplasty with Tympanoplasty: 10(34%) • With canal wall down Mastoidectomy and Tympanoplasty: 7(24%)

  10. Wehr’s 2.7mm Incus Replacement Prosthesis-Resultspossible SRT<30db:25 Post op SRT< 30dB:13/25(52%)A-B Closure

  11. Wehr’s 2.7mm Incus Replacement Prosthesis-Complications • Hearing worse: 3 (10%) • Hyperacusis: 1 (3%)

  12. Wehr’s mm Incus-Stapes Replacement Prosthesis • N=36 • Average age:34 years (5-67) • Average follow-up : 25 months(1-66)

  13. Wehr’s Incus-Stapes Replacement Prosthesis- Pre-op Diagnosis • Chronic Otitis Media : 16 (44%) • Cholesteatoma: 18 (50%) • Congenital malformation:2

  14. Wehr’s 2.7mm Incus-Stapes Replacement Prosthesis-Type of repair • Ossiculoplasty: 11(31%) • Ossiculoplasty with Tympanoplasty:13(36%) • With canal wall down Mastoidectomy and Tympanoplasty : 12(33%)

  15. Wehr’s Incus-Stapes Replacement Prosthesis- Resultspossible SRT<30db:32 Post op SRT< 30dB:19/32(59%)A-B Gap Closure * 1 overclosure

  16. Wehr’s 2.7mm Incus-Stapes Replacement Prosthesis-Complications • Hearing worse: 1 • Extrusion: 1 (4 years) • Dislocation: 1

  17. Malleus-Stapes Assembly • N=26 • Average age : 37 years (12-71) • Average follow-up:22 months(1-63)

  18. Malleus-Stapes Assembly-Pre-op Diagnosis • Chronic Otitis Media: 16 (62%) • Cholesteatoma:6 (23%) • Trauma: 1 • Malleus Head Fixation: 3

  19. Malleus-Stapes Assembly-Types of Repair • Ossiculoplasty: 12(46%) • Ossiculoplasty with Tympanoplasty:10(38%) • With canal wall down Mastoidectomy and Tympanoplasty: 4

  20. Malleus-Stapes Assembly-ResultsA-B gap closure Possible SRT<30dB :22 Post-op SRt<30dB: 11/22 (50%)

  21. Malleus-Stapes Assembly-Complications • Worse Hearing: 5(19%)

  22. Assemblies- Total (N=119) • Pre-op diagnosis • Chronic Otitis Media: 72(61%) • Cholesteatoma:35(29%) • Trauma:2 • Malleus Head Fixation:8 • Congenital:2

  23. Assemblies-Types of repair • Ossiculoplasty: 47 (39%) • Ossiculoplasty with Tympanoplasty:47(39%) • Ossicuplasty withTympanoplasty and canal wall down Mastoidectomy: 25(21%)

  24. Assemblies-ResultsA-B gap closurepossible SRT<30dB:102 Post op<30dB:58/102(57%) * 1 overclosure

  25. Assemblies-Complications • Hearing worse: 8(7%) • Hyperacusis: 1 • Extrusions: 1 • Dislocation: 1

  26. Torps and Porps • N=14 • Average age:40 years.(4-65) • Average follow-up:21 months(6-49)

  27. Torps and Porps- Pre-op Diagnosis • Chronic otitis media:8(57%) • Cholesteatoma: 4(29%) • Congenital malformation: 1 • Malleus head fixation:1

  28. Torps and Porps- Types of Repair • Ossiculoplasty:2 • Ossiculoplasty with Tympanoplasty:11(79%) • With canal wall down Mastoidectomy and Tympanoplasty : 1

  29. Torps and Porps- ResultsA-B gap closurepossible Sat<30dB:12 Post op Sat<30dB:4/12(25%)

  30. Torps and Porps: Complications • Extrusion:1(7%)

  31. Conclusions • Assemblies better than torp’s and porp’s(60% vs 25% success) • ?Effectiveness of malleus-stapes assembly • ?which prosthesis • Safe • Long term results problematic • Single stage procedures reasonable • ?Cost effective • ?Use of aids after failure

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