Ossiculoplasty With Titanium Prostheses in Patients With Intact Stapes: Comparison of TORP Versus PORP.

ABSTRACT

OBJECTIVES: Inferior rotation of the stapes or a small middle ear cleft can make placement of partial ossicular replacement prostheses (PORP) challenging. This study examines outcomes of total titanium prosthesis (TORP) ossiculoplasty in such patients and compares the results to PORPs. STUDY DESIGN: Review of prospective database. SETTING: Tertiary hospital. PATIENTS Patients with an intact/mobile stapes undergoing titanium ossicular chain reconstruction from 2002 to 2014. INTERVENTION Ossicular chain reconstruction. OUTCOMES: Hearing outcomes included ABG, closure of ABG(ΔABG), SRT, improvement in SRT(ΔSRT), achievement of ABG ≤20 dB, and stability over time. RESULTS: Eighty-three patients were included; 56 were PORPs and 27 were TORPs. At initial follow-up (<6 mo), mean ABG and ΔABG in the TORP group were 20.6 and 11.7 dB, respectively. Postoperative ABG≤20 dB was achieved in 60.0% of TORPs. At longer-term follow-up (mean 54.0 mo), hearing remained stable in TORPs. Specifically, the mean ABG and ΔABG were 17.7 and 13.3 dB, respectively. Sixty-three percent of TORPs achieved ABG ≤20 dB at later follow-up. When compared PORPs at both short and longer-term follow-ups, no differences in hearing outcomes were noted. A small, but statistically significant, deterioration in both ABG and SRT was observed within the PORP group (p = 0.02 and <0.01, respectively). CONCLUSION: TORP reconstruction in patients with an intact stapes is associated with good short and longer-term hearing results. Furthermore, hearing outcomes within TORPs remain stable at follow-up >12 months postoperatively. Results did not differ when compared with traditional PORP reconstruction, suggesting that TORP through an intact stapes arch is an acceptable alternative to PORP reconstruction in patients with challenging anatomy.