Predictors of hearing outcomes in patients undergoing ossicular chain reconstruction in a developing country / Factores predictores de desenlaces auditivos en pacientes llevados a reconstrucción de la cadena osicular en un país en vía de desarrollo

Objective: To explore the social and clinical factors that predict audiometric outcomes in patients undergoing ossicular chain reconstruction. Methods: A retrospective analytical cohort study was conducted, including patients 18 years of age or older with a history of chronic otitis media (COM) and/or any of its complications, who underwent ossicular chain reconstruction with Partial Ossicular Replacement Prosthesis (PORP) or Total Ossicular Replacement Prosthesis (TORP), at Hospital San José and Hospital infantile Universitario de San José between 2012 and 2020. We excluded patients with ossicular chain malformations and those with incomplete information. Information about sociodemographic and clinical factors was collected. Additionally, the surgery findings information was analyzed using the Ossiculoplasty outcome parameter staging ( OOPS) index. Results: A total of 35 adult patients who underwent ossicular chain reconstruction were retrospectively studied. An improvement was evidenced in the Preoperative Pure-Tone Average (PTA) and postoperative PTA (p-value=0.036), as well as in the pre and postoperative air-bone gap (ABG) (p-value < 0.01). A moderate correlation coefficient was found between the OOPS index and the postoperative PTA (p= 0.429), and between the OOPS index and the postoperative (ABG) (p= 0.653). Conclusion: We found that a higher OOPS score is correlated with worse hearing outcomes postoperatively, and there was no association between the demographic or pathologic factors with a worse postoperative hearing outcome. Therefore, OOPS index can predict audiometric outcomes in patients undergoing ossicular chain reconstruction in a developing country, regardless of the demographic or pathologic factors.

Objetivo: Evaluar los factores sociales y clínicos que predicen los desenlaces audiométricos en pacientes llevados a reconstrucción de cadena osicular en un país envía de desarrollo. Métodos: Se realizo un estudio de cohorte analítico retrospectivo donde se incluyeron pacientes mayores de 18 años, con antecedente de otitis media crónica y/o alguna complicación/secuela de esta, que fueron llevados a reconstrucción de la cadena osicular con prótesis PORP - TORP de la Fundación Universitaria de Ciencias de la Salud entre el año 2012 y 2020, se excluyeron pacientes con malformaciones de la cadena osicular y aquellos con informacion incompleta de su historia clinica y quirurgica. Resultados: La población estudiada fue 35 pacientes, en los cuales se compararon variables demográficas, antecedentes de rinitis o tabaquismo activo, parámetros audiológicos pre y postoperatorios, y hallazgos intraquirurgicos. Se evidenció una diferencia estadísticamente significativa entre el promedio tonal auditivo (PTA) preoperatorio y el PTA postoperatorio (p-valor=0.036), así como en el gap aéreo- oseo pre y post operatorio ( p-valor < 0.01). Se reportó un coeficiente de correlación moderado entre el índice OOPS y el PTA post operatorio (p = 0.429), y entre el índice OOPS y el gap aéreo óseo post operatorio (p = 0.653), lo que indica que a mayor puntaje en el índice OOPS peores desenlaces auditivos. Conclusión: En este estudio un mayor puntaje en el índice OOPS se correlacionó con peores desenlaces auditivos. No se evidenció correlación entre los factores demográficos u otras comorbilidades descritas y un peor desenlace auditivo post operatorio. Aunque se obtuvo un GAO postoperatorio ≤20dB en el 48.5% de los pacientes, se observó una disminución en el GAO estadísticamente significativo.

Recommendations for post-rehabilitation care of maxillofacial prostheses

Aim: This study aimed to review the scientific literature to describe the main care and hygiene protocols for different types of maxillofacial prostheses (MFP). Methods: A bibliographic search on the PubMed / Medline database using the following keywords: ["maxillofacial prosthesis" OR "ocular prostheses" OR "palatal obturators"] AND ["Cleaning" OR "disinfection"] AND ["care"] AND ["color stability"] OR ["denture cleansers" OR "cleansing agents"]. Articles addressing materials, cleaning and disinfection protocols, and care related to MFP were included. The following exclusion criteria were applied: no adequate methodology, incompatibility with the area of interest, and unavailability for reading in full. Results: The papers were grouped into the following topics: facial prostheses, ocular prostheses, maxillofacial intraoral prostheses, and retention systems. Conclusion: Despite the MFP changes over time, its degradation decreases upon following the recommendations and post-adaptation care. The guidelines for cleaning and disinfection must be individualized to guarantee the longevity of the prosthesis and the patient health

[Revision surgery after stapedectomy]. / Revisionsoperationen nach Stapesplastik.

Revision stapes surgery is considered to be significantly more demanding than primary stapes surgery, both in terms of the indication and the surgical approach. This article reviews common indications for revision after stapedectomy as well as the surgical approaches and intraoperative findings. A distinction is made between revision surgeries, which are usually carried out because of conductive hearing loss a long time after stapes surgery, and acute or subacute revisions that become necessary in the immediate postoperative course. With the shortening of postoperative observation times under inpatient conditions as a result of increasing economization and the associated shift of the immediate postoperative phase to the outpatient setting, the recognition of postoperative irregularities is also becoming increasingly important for otorhinolaryngologists in private practice, even if they do not perform these highly specialized interventions themselves.

Audiologic results of total ossicular replacement prosthesis bypassing the stapes suprastructure in canal wall down mastoidectomy.

OBJECTIVES: Sometimes performing PORP adequately is challenging when the stapes is tilted or the suprastructure is partially damaged owing to inflammation or infection. In such cases, the implementation of a TORP bypassing the stapes can be a useful alternative. This study aimed to investigate whether bypassing the stapes suprastructure during total ossicular replacement prosthesis (TORP) affects postoperative complications or audiological outcomes. MATERIAL AND METHODS: Among 104 patients who underwent open cavity mastoidectomy and ossiculoplasty using a titanium prosthesis at Korea University Ansan Hospital between January 2012 and December 2019, we compared the preoperative and postoperative audiological results and surgical complications of 52, 21, and 31 patients who underwent partial ossicular replacement prosthesis (PORP), TORP bypassing the remaining stapes suprastructure, and TORP on the stapes footplate or oval window, respectively. RESULTS: The air-bone gap before surgery was significantly different in the TORP on the stapes footplate group (34.2 ± 12.0 dB) than that in the PORP (22.9 ± 13.8 dB) and TORP bypassing the stapes groups (20.7 ± 11.5 dB, p < 0.001). After surgery, there were no significant differences among the groups (p = 0.818). The air-bone gap difference before surgery was associated with the presence of stapes before surgery (p < 0.001). There was no difference in the proportion of postoperative tympanic perforation, whether it was a revision surgery, malleus status, or the size of perforation of the tympanic membrane among the three groups. CONCLUSION: When performing ossiculoplasty using TORP, bypassing the stapes did not affect surgical and audiologic outcomes.

3D-printed custom ossicular prosthesis - methodology of design and LDV measurements in a cadaver study.

OBJECTIVE: In tympanoplasty, surgical reconstruction of the tympanic membrane and ossicular chain is well-established; however, its hearing results still require improvement. Custom 3D printing of individualized ossicular prostheses seems to be an attractive solution for optimal prosthesis adjustment and better hearing results. AIM: The aim was to design a custom ossicular prosthesis using a 3D printing method based on Cone-beam Computed Tomography (CBCT) scans and assess the acoustic conduction properties of such prosthesis. MATERIAL AND METHODS: A cadaver fresh frozen temporal bone was used. Based on CBCT images, a new incus prosthesis was designed and 3D printed. Next, canal wall-up tympanoplasty was performed. The intact ossicular chain and reconstructed 3D-printed prosthesis chain movements/vibrations were measured with Laser Doppler Vibrometer (LDV) system and analyzed in detail. RESULTS: The CBCT scans provided enough information about the anatomical structures. For frequencies 500 and 1000 Hz and 80 dB SPL sound intensity, collected velocities were higher for the intact ossicular chain than the 3D-printed ossicular prosthesis. The intensity thresholds for movement at 500 and 1000 Hz were lower in the intact ossicular chain than in the 3D-printed ossicular prosthesis. At 2000 Hz, there was the same intensity threshold value in the two measured circumstances. CONCLUSION: It is possible to design a custom individually fitted ossicular prosthesis using a 3D printing method based on CBCT scans. The acoustic conduction properties of such 3D-printed prosthesis showed differences in movability pattern between the intact and reconstructed ossicular chain. More data are needed to analyze the acoustic properties of such designed prostheses in detail. The results of our experiment showed the 3D-printed prosthesis presents the potential to be an interesting option for conductive hearing loss treatment caused by chronic otitis media and the ossicular chain defects.

Comparison between incus short process and long process coupling of the vibrant soundbridge in human temporal bones.

OBJECTIVE: The Vibrant Soundbridge (VSB) is one of the most widely used implantable hearing devices. It consists of a vibrating floating mass transducer (FMT) that is connected to a middle ear structure. The standard coupling devices for sensorineural hearing loss are short process (SP) or long process (LP) couplers. DESIGN AND STUDY SAMPLE: This study directly compared the electro-mechanical performance of the SP- and LP-coupled FMT of the VSB in the same temporal bone specimen (n = 10). We measured velocity magnitudes and total harmonic distortions (THD) of the stapes (ST) and the round window (RW) using laser Doppler Vibrometry (LDV). RESULTS: Comparison shows a maximally 10 dB higher magnitude for the LP coupler at ST and RW for frequencies below 600 Hz, whereas the SP coupler shows a maximally 20 dB higher magnitude at the ST and RW for frequencies above 600 Hz. THD show similar behaviour with less distortion at 500 Hz for the LP coupler and less distortions for the SP coupler in higher frequencies. CONCLUSIONS: Our experiments showed that the SP coupling may be mechanically favourable, in terms of magnitude and distortion, for the transmission of FMT vibrations at higher frequencies.

Comparison of Surgical Outcomes Between Ossicle-Cartilage Composite Graft and Synthetic Ossicular Prosthesis for Ossicular Reconstruction.

OBJECTIVE: To propose a modified technique of ossiculoplasty using an ossicle-cartilage composite graft (OCCG) and compare its hearing outcome and protrusion rate with those of a synthetic prosthesis. METHODS: Autologous tragal or homologous septal cartilage was combined with an ossicle to create an umbrella shape OCCG. A total of 302 ossiculoplasty surgeries performed in a single university hospital between 1997 and 2006 were retrospectively reviewed based on the prosthesis type-OCCG or polymaleinate ionomeric prosthesis (IONOS®). Data includes demographic profiles, audiometric outcomes, intraoperative findings, and post-operative complications and was categorized by the follow-up periods. RESULTS: Ossicle-cartilage composite graft was used for 175 patients and IONOS® for 127 patients. The mean post-operative air-bone gap (ABG) of the OCCG group was 22.36 dB, which was better than the IONOS® group of 25.08 dB (P = .015). The successful ABG closure rate of less than 20 dB was also higher in the OCCG group compared to the IONOS® group (38.3% vs 26.8%, P = .036). The ABG between the pre- and post-operative conditions exhibited a significant difference between the 2 groups (P = .006). In the data divided into 3 groups according to the follow-up period, the OCCG group showed a better outcome in the long-term follow-up with 0 cases of protrusion during the follow-up period in the OCCG group compared to 8 cases of the IONOS® group (P = .018). CONCLUSION: Ossiculoplasty with OCCG exhibited satisfactory audiometric outcomes and low complication rates. Ossicle-cartilage composite graft can be a good option with sufficient informed consent and preliminary screening of transmitted diseases.

[Allergic reactions to bioimplants]. / Allergische Reaktionen auf Bioimplantate.

BACKGROUND: Bioimplants are used in a variety of ways in otorhinolaryngology, most commonly in facial reconstructive surgery, cochlear implants (CI), bone-anchored hearing aids, and partial/total ossicular replacement prostheses (PORP/TORP), but also for tympanic drainage, laryngeal cannula, voice prostheses after laryngectomy, etc., and in otorhinolaryngology-related procedures as dental implants in dentistry. METHODS: A literature search was performed to analyze the immunology of allergic reactions to bioimplants and to determine the available evidence by searching Medline, PubMed, and national and international study and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 were considered. RESULTS: Based on the international literature and previous experience, a review of allergies to bioimplants in otolaryngology is presented. CONCLUSION: Otorhinolaryngologists should always consider the possibility of allergic reactions when inserting allogeneic materials, particularly, but not only, when using bioimplants.

Ossicular chain reconstruction using costal cartilage in malleoincudal osteoma.

OBJECTIVES: To report an extremely rare case of malleoincudal osteoma that led to conductive hearing loss despite an unusually normal otomicroscopic appearance, and to highlight the usefulness of costal cartilage for ossicular chain reconstruction after tumour removal. CASE REPORT: A 37-year-old woman presented with a 2-year history of progressive, right-sided hearing loss. Physical examination revealed a normal tympanic membrane. Pure tone audiometry showed a right-sided conductive hearing loss. High-resolution computed tomography revealed a right-sided epitympanic mass arising from the malleus head and contiguous with the incus. The patient underwent a closed mastoido-epitympanectomy. The malleus head and the incus with associated malleoincudal osteoma were removed. Ossicular chain reconstruction using costal cartilage was performed at the time of tumour removal. CONCLUSION: The possibility of a middle-ear osteoma must be considered in cases of unilateral and progressive conductive hearing loss with a normal otomicroscopic appearance in patients with no history of ear infection, trauma or prior surgery, and with no family history of hearing loss. Surgical treatment is indicated in cases of significant conductive hearing loss. To our knowledge, this is the first case report of malleoincudal osteoma in which the ossicular chain was reconstructed using costal cartilage.

Evaluating hearing results in stapedotomy: Comparison of fluoroplastic Causse loop piston and Matrix prosthesis.

OBJECTIVE: We carried out this research to assess and compare post-stapedotomy hearing results of Matrix titanium prosthesis with a Teflon piston prosthesis, specifically the fluoroplastic (Teflon) Causse loop piston prosthesis in patients who suffered from otosclerosis. METHODOLOGY: In this retrospective study, Causse loop piston prosthesis was used in 81 ears, and the Matrix prosthesis was applied in 44 ears. For pairwise matching with Matrix prosthesis, 44 out of 81 Causse loop piston-treated ears were selected based on preoperative audiometric data. Then, postoperative audiometric results of these two groups were compared. The main outcomes were pure tone audiometric results and air-bone gap (ABG) closure before and after the surgery. Incidence of postoperative sensorineural hearing loss was also evaluated and compared between the two groups. RESULTS: The results revealed no significant difference in improvement of speech reception threshold, mean air conduction, bone conduction gain, ABG closure, and incidence of postoperative sensorineural hearing loss at the frequencies of 0.5-4 kHz between the two groups. However, performance of Matrix prosthesis was better in ABG closure at a frequency of 250 Hz. CONCLUSION: Herein, similar postoperative improvement was achieved at the frequencies of 0.5-4 kHz; nevertheless, Matrix provided better ABG closure at frequency of 250 Hz in short term. LEVEL OF EVIDENCE: 4.

[Anatomical and functional results of ossiculoplasty with adjustable length titanium prostheses with and without hydroxyapatite]. / Anatomicheskie i funktsional'nye rezul'taty ossikuloplastiki s ispol'zovaniem titanovykh protezov s reguliruemoi dlinoi s gidroksiapatitom i bez nego.

OBJECTIVE: To compare the anatomical and functional results of the ossicular chain reconstruction with classic titanium adjustable prostheses and titanium adjustable prostheses with hydroxyapatite cap. MATERIAL AND METHODS: The 300 patients (360 cases) with chronic suppurative otitis media were examined and operated. The patients are divided into 2 groups. Group A included patients who received an ossicular prosthesis with a hydroxyapatite cap (90 cases with a partial prosthesis and 90 with a full one). Group B included patients who received prostheses without hydroxyapatitis (90 cases with a partial prosthesis and 90 with a complete one). The patients who received a prosthesis with a hydroxyapatite cap were divided into two subgroups, depending on the autotissue, which was placed between the prosthesis cap and the nontympanic membrane: this is an autocartilage plate or perichondrium/fascial graft. The follow-up period after surgery was 38.5±14.4 months (from 12 to 48 months). In the long-term postoperative period, the subjects were assessed the values of the bone-air gap (BAG), the consistency of the nontympanic membrane, and the presence of signs of extrusion of the prosthesis cap. Comparison of anatomical and functional results between patients with full and partial ossicular prostheses was performed separately. RESULTS: A good result in the form of a 20 dB or more dB BAG reduction was achieved in 82.2% of patients who received a partial prosthesis (85 patients in group A and 63 in group B), and in 57.8% of patients who received a complete prosthesis (45 patients in group A and 59 in group B). The BAG values in the long-term period after surgery did not statistically significantly differ between patients who received a prosthesis with a hydroxyapatite cap or a fully titanium one (p=0.939 for patients with full prostheses and p=0.745 for patients with partial prostheses). The placement of cartilage or perichondrium/fascial graft between the hydroxyapatite prosthesis cap and the nontympanic membrane also did not affect the functional outcome (with full prostheses - p=0.651, with partial prostheses - p=0.142). CONCLUSION: It is possible to use ossicular prostheses with a hydroxyapatite cap without placing an autocartilaginous plate between the nontympanic membrane and the cap of the prosthesis. In the long term period, functional and anatomical results with hydroxyapatite cap prostheses do not differ statistically significantly from those with all-titanium prostheses.

[The experience in surgical treatment of hearing loss in Van der Hoeve patients]. / Opyt khirurgicheskogo lecheniya tugoukhosti u patsientov s sindromom Van-der-Khuve.

Despite the rare incidence of Van der Hoeve syndrome in the population, the problem of treating patients with this type of disease is important for modern science and practical medicine. One of the most difficult tasks in treatment is to improve the quality of hearing. The world scientific community lacks a unified coordinated approach to the methods of auditory rehabilitation of patients with Van der Hoeve syndrome. In recent years, there have been tendencies in the scientific literature to increase the frequency of non-surgical approach due to the low incidence of satisfactory results of surgical treatment. In this regard, we present our experience of complex treatment of patients with Van der Hove syndrome, based on the use of modern surgical technologies and conservative pathogenetically substantiated treatment.

[From reconstruction to function : Hands-on training in tympanoplasty using real-time feedback]. / Von der Rekonstruktion zur Funktion : Tympanoplastik-Training mit Real-Time-Feedback.

BACKGROUND: Surgery of the middle ear requires a very high level of fine motor skills. Due to the increased potential for complications in middle ear operations, it is appropriate to acquire these skills beforehand by operating on a model. OBJECTIVE: How satisfactory is the training on suitable models? Are the skills acquired from working on a model transferable to intraoperative situations? Will the type of model and its use for training influence ear surgery in the future? MATERIAL AND METHODS: Available publications and own experiences with the Dresden tympanoplasty model (DTM) are analyzed and discussed. RESULTS: Although middle ear surgery makes very high demands on the surgeon and there is a significant risk for severe complications to the ear as a sense organ, there are currently very few options to train surgeons in advance. The DTM is a validated training model, which is capable of closing this gap. Due to the possibility of using a real-time feedback variation of the model, the understanding for reconstruction quality and intraoperative acoustic stress can be improved. The translation of the real-time feedback idea into actual middle ear surgery can improve reconstruction quality in the future. CONCLUSION: Training on suitable models is indispensable, especially when training as a surgeon to carry out middle ear operations. Adding another sense perception to the internal and external quality assessment of tympanoplasty by inclusion of the real-time feedback option, can optimize learning and operating processes.

TORP ossiculoplasty in the presence of an intact stapes superstructure.

INTRODUCTION: In this series, we describe ossicular reconstruction using routine TORP in the presence of the stapes superstructure using a tympanic-membrane-to-footplate configuration. MATERIALS AND METHODS: This is a case series of 12 patients who underwent TORP ossiculoplasties from 1st January 2010 to 31st October 2017. Data collected included demographics, indication for surgery, status of the middle ear and pre-operative and post-operative audiometric data (including pure tone average (PTA) and air-bone gap (ABG)). RESULTS: The mean pre-operative PTA was 56.5 dB and ABG was 39.8 dB. Surgical success (ABG ≤ 20 dB) was achieved in 83.3%, with an average improvement in PTA of 24.3 dB and closure of ABG of 27.1 dB. The mean post-operative ABG was 12.7 dB. CONCLUSION: TORP ossiculoplasty with tympanic-membrane-to-footplate configuration is a feasible means of ossicular reconstruction, independent of the status or spatial arrangement of the remnant ossicles. Using this technique, it is possible to achieve a consistently good outcome for improvement in hearing and closure of ABG.

Middle Ear Implant in a Patient With Fibrous Dysplasia: An Alternative for Hearing Restoration.

We propose middle ear implants (MEI) as alternative hearing restoration option for patients with fibrous dysplasia of the temporal bone (FDTB). A 60-year-old man presented with unilateral right-sided conductive hearing loss (CHL) and FDTB. The Vibrant Soundbridge (VSB) MEI was implanted in the right ear. Preoperatively, the right side had a pure tone average (PTA) threshold of 67 dB, speech reception threshold (SRT) = 75 dB HL, and speech discrimination score (SDS) = 54% at 80 dB HL presentation level. Postoperative aided PTA threshold of the right ear was 28 db, aided SRT = 30 db, and SDS = 96% at 65dB HL. After excluding cholesteatoma, VSB provides an alternative hearing restoration technique for adults with FDTB and CHL due to stenosis of the external auditory canal and/or ossicular crowding.

Prótese auditiva ancorada ao osso percutânea: benefícios auditivos / Percutaneous bone ancored hearing aid: hearing benefits

RESUMO Objetivo Descrever os benefícios nos limiares auditivos e no desempenho de reconhecimento de sentenças no silêncio e no ruído em indivíduos com a adaptação unilateral do Sistema Ponto®. Métodos Estudo observacional, retrospectivo, de seguimento longitudinal. A casuística foi composta por fontes de dados secundários de dez indivíduos com perda auditiva condutiva ou mista, que foram submetidos à cirurgia com o Sistema Ponto®. Os resultados foram analisados nas seguintes condições: a) pré-cirúrgicas: sem AASI; com AASI por condução aérea ou óssea e com o processador Ponto Pro® acoplado a uma banda elástica; b) pós-cirúrgicas: na ativação e após seis meses de uso. Resultados Os limiares da audiometria tonal por conduções aérea e óssea mantiveram-se estáveis após a cirurgia, enquanto os limiares auditivos em campo livre e o reconhecimento de fala no silêncio e no ruído foram estatisticamente melhores na ativação e após seis meses de uso do Sistema Ponto®. Não houve diferença nos resultados com os indivíduos utilizando o Sistema Ponto® com a banda elástica e após a cirurgia. Conclusão O Sistema Ponto® propiciou benefício nas habilidades auditivas de detecção em todas as frequências testadas, assim como no reconhecimento de sentenças no silêncio e no ruído.

ABSTRACT Purpose To describe the benefits in hearing thresholds and sentence recognition performance in silence and noise, in users of the unilateral Ponto® system. Methods An observational, retrospective, longitudinal study. The sample consisted of secondary data sources from 10 individuals with conductive or mixed hearing loss who underwent surgery with the Ponto® System. The results were analyzed in the following pre-surgical conditions (without hearing aids; with hearing aids by air or bone conduction; with the Ponto Pro® processor with a soft band) and post-surgical (on activation and after six months of use). Results The thresholds of pure tone audiometry by air and bone conductions remained stable after surgery, while the auditory thresholds in free field and speech recognition in silence and in noise were statistically better when using the Ponto® system. There was no difference between the results obtained with the individuals using Ponto® with soft band and post-surgically. Conclusion The Ponto® system provided benefits in hearing detection skills in all tested frequencies, as well as, in recognition of the sentence in silence and noise.

[Study on preparation of 3D printing degradable tissue engineering ossicles].

Objective: In combination with 3D printing technology and degradable composite materials, to discuss the preparation method of tissue engineering ossicles for middle ear hearing reconstruction. Methods: Domestic polymer (polylactic acid-glycolic acid copolymer, PLGA) and degradable ceramic material (ß-tricalcium phosphate, ß-TCP) were selected and prepared by low temperature deposition method according to the design ratio to Program according to the outline design code of the required scaffold to generate appropriate print files, and then the self-developed low-temperature deposition printing device was used to prepare tissue-engineered osseous scaffolds in accordance with the print files in a low-temperature environment. The scaffolds was freeze-dried and sterilized for later use after printing. Light microscopy and scanning electron microscopy were used to observe the apparent characteristics and internal structure of the scaffolds and to check its pore size, porosity and mechanical properties. Results: After printing, a degradable scaffold was obtained. Under the optical microscope, it was a small cylindrical shape with a diameter of 1.5 mm and a length of 6.0 mm, and its surface had micropores. The degradable scaffold had a horizontal and vertical interlaced warp and weft structure, the wire spacing was 1.2 mm, and the pores were connected to each other. The surface could see circular or quadrangular pores with a pore size of about 100-400 µm. The diameter of the inter-pore cross-linked channels was about 50 µm and the diameter of the surrounding circular micropores was about 10-40 µm. ß-TCP particles with a size of about 700 nm were attached to the surface of the PLGA material. The average porosity of the whole scaffolds was (83.43±0.01)%, and the content of BMP-2 loaded was about 0.7 µg/mm(3). After freeze-drying, the mechanical strength of the scaffold was moderate, and there was no obvious deformation during stretching and compression, which met the mechanical requirements of tissue engineering ossicles. Conclusions: Using the low-temperature deposition printing method and strictly controlled processes and conditions, a polymer-degradable ceramic ossicle tissue engineering scaffold can be prepared for implantation experiments. The scaffold has suitable porosity and mechanical properties, and can be loaded with osteoinductive factors.

Concurrent Occurrence of Congenital Ossicular Anomaly and Localized Cholesteatoma: Series of 10 Cases.

OBJECTIVE: The objective of this study is to describe the clinical features, managements and outcomes of a rare coexistence of congenital ossicular anomaly and localized cholesteatoma. A literature review on these cases and each congenital disorder is also presented. METHODS: A retrospective chart review was performed on patients diagnosed with congenital ossicular anomaly with concurrent localized cholesteatoma from 2008 to 2017. Clinical data of these patients were collected. RESULTS: A total of 10 patients were identified. All patients presented with unilateral hearing loss. Pure-tone audiometry showed conductive hearing loss in all affected ears with an average air conduction (AC) threshold of 59 dB. High-resolution computed tomography scans of the temporal bone diagnosed ossicular anomaly for 90% (9/10); however, only 50% (5/10) had a diagnosis of localized cholesteatoma. A transcanal exploratory tympanotomy under the microscope was performed to discover whether the localized tiny-sized cholesteatoma around the ossicular chain did not have direct contact with the ossicular chain, which could be diagnosed as congenital cholesteatoma. We removed the localized cholesteatoma and reconstructed the ossicular chain in each patient. All localized cholesteatomas were found in the posterior-superior quadrant of the middle ear. Ossicular chain anomalies were associated with the incus and/or the stapes in all cases. Hearing improvement was achieved in each of the 6 patients who were followed up postoperatively, with an average AC threshold of 35 dB. The clinical features of congenital ossicular anomaly with concurrent congenital cholesteatoma were compared with those of each congenital disorder. The pathogenesis of each condition was also discussed. CONCLUSIONS: Congenital ossicular anomaly with concurrent congenital cholesteatoma is rare. It shares similar clinical features with congenital ossicular anomaly occurring alone, therefore awareness should be raised for a possible concurrent congenital cholesteatoma which was easy to miss in the diagnosis (50%) by the radiologist. A patient's hearing level can be improved by removal of the cholesteatoma and reconstruction of the ossicular chain. Localized cholesteatoma does not usually show residuals or recurrence.

Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors / Reconstrução da cadeia ossicular na otite média crônica: resultados auditivos e análise de fatores prognósticos

Abstract Introduction The goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors. Objective Analyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery. Methods Charts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz. Results Reconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB. Conclusion We achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.

Resumo Introdução A ossiculoplastia tem como objetivo a melhoria da audição e o sucesso desse procedimento depende de diversos fatores. Objetivo Analisar os resultados auditivos em pacientes com otite média crônica submetidos a reconstrução da cadeia ossicular, bem como os fatores preditivos de sucesso cirúrgico. Método Prontuários de pacientes submetidos a ossiculoplastia entre 2006 e 2016 foram revistos. Sessenta e oito pacientes foram incluídos, total de 72 orelhas. Os seguintes dados foram analisados: sexo, idade, tabagismo, lateralidade, doença, exames audiométricos, tipo de cirurgia, cirurgia prévia, características da orelha média, otorreia e estado da cadeia ossicular. Os pacientes também foram classificados de acordo com dois índices: índice de risco da orelha média e estadiamento do parâmetro de desfecho da ossiculoplastia. Os resultados foram avaliados comparando o gap aéreo-ósseo antes e após a cirurgia. O sucesso da reconstrução foi definido como gap aéreo-ósseo ≤ 20 dB e a melhoria dos limiares de recepção de fala, calculados pelas frequências médias de 0,5, 1, 2 e 3 kHz. Resultados A taxa de sucesso da reconstrução foi de 61%. O gap aéreo-ósseo pré-operatório médio foi de 34,63 dB e diminuiu para 17,26 dB após a cirurgia. Houve correlação entre baixo risco no índice de risco para orelha média e os índices de estadiamento do parâmetro de desfecho da ossiculoplastia com sucesso pós-operatório. O ossículo com erosão mais frequente foi a bigorna e o tipo de prótese mais utilizada foi a cartilagem tragal. Nos pacientes sem bigorna o sucesso foi alcançado em 74,2% das cirurgias. Na ausência do estribo, a taxa de sucesso diminuiu para 63,3%. Na ausência do martelo, 85% dos pacientes apresentaram gap aéreo-ósseo ≤ 20 dB. Conclusão Melhora significativa da audição foi observada em pacientes submetidos à ossiculoplastia, os resultados foram comparáveis aos de outros centros. O "status" dos ossículos influenciou os resultados pós-operatórios, principalmente a presença do estribo. Também concluímos que os índices analisados podem ajudar a prever o sucesso da cirurgia.

Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors.

INTRODUCTION: The goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors. OBJECTIVE: Analyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery. METHODS: Charts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3kHz. RESULTS: Reconstruction success rate was 61%. The mean preoperative air bone gap was 34.63dB and decreased to 17.26dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20dB. CONCLUSION: We achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.