Displacement of a Total Ossicular Replacement Prosthesis Following Ossicular Chain Reconstruction.

OBJECTIVE: Herein we describe the diagnosis and management of total ossicular replacement prosthesis (TORP) displacement following tympanoplasty with ossicular chain reconstruction (OCR). METHODS: Case report with literature review. RESULTS/CASE: A 40-year-old male with otorrhea and tympanic membrane perforation underwent a right revision tympanoplasty with OCR using a TORP with a tragal chondroperichondrial graft. On postoperative day (POD) 4, he developed vertigo and profound right-sided hearing loss. Temporal bone computed tomography showed the prosthesis in the vestibule. After a steroid taper with mild improvement in symptoms, the TORP was removed two weeks later and the patient continued to improve. CONCLUSION: TORP displacement into the vestibule is a very rare complication following OCR. Conservative management with high dose steroids may improve symptoms, however further middle ear exploration and surgical management may be warranted depending on the depth of displacement into the inner ear as well as symptom severity.

Long-Term Stability and Safety of the Soundbridge Coupled to the Round Window.

OBJECTIVE: The objective of the study was to demonstrate the long-term outcomes of patients implanted with the active middle ear implant (AMEI) Vibrant Soundbridge (VSB) through coupling the floating mass transducer (FMT) to the round window (RW). METHODS: This retrospective study evaluated the short- and long-term clinical performance (audiological outcomes) and safety (revisions/explantations) of the VSB coupled to the RW between 2013 and 2019 at the St. Pölten University Hospital, Austria. For the outcome analysis, the sample was divided into a short-term examination group followed up for less than 12 months (<12 months) and a long-term examination group followed up for more than 12 months (>12 months). Cumulative survival outcomes were separately analyzed for subjects with and without cholesteatoma. RESULTS: 46 patients with an average long-term follow-up period of 31.43 months (13-75 months) were investigated. Complications requiring revision surgery were reported in total in seven patients with cholesteatoma (15.2%) and none in subjects without cholesteatoma (0%). Residual hearing was not affected by VSB surgery. Word understanding on the Freiburger monosyllabic speech test improved significantly at 65 dB (P < .0001) and 80 dB (P < .0001), and these outcomes were stable for long-term follow up. CONCLUSION: The VSB coupled to the RW is a safe implantation method for patients with conductive or mixed hearing loss. Hearing improvement was stable for the long-term follow-up up to 74 months. The revision rates are directly related to the underlying pathology of cholesteatoma (with radical cavity); thus, this special cohort requires additional counseling on potential complications. LEVEL OF EVIDENCE: 4 (Case-series) Laryngoscope, 131:E1434-E1442, 2021.

Vibroplasty combined with tympanic membrane reconstruction in middle ear ventilation disorders.

Although the Vibrant Soundbridge is one of the most frequently used active middle ear implants, data regarding how middle ear ventilation disorders may affect the transmission behavior of its floating mass transducer are still insufficient. Studies involving coupling the floating mass transducer to the stapes head are particularly lacking. This temporal bone study evaluated the influence of simulated middle ear ventilation disorders on the middle ear transfer function in the reconstructed middle ear. The middle ear transfer function was measured using Laser Doppler Vibrometry after vibroplasty onto the stapes head, with or without tympanic membrane reconstruction. Middle ear ventilation disorders were simulated through changes in static pressure via the external ear channel with a maximum pressure of +3 kPa. Slice thickness of tympanic membrane reconstruction material was measured using micro-CT. When the reconstructed ossicular chain and the reconstructed tympanic membrane were mechanically excited by the floating mass transducer under conditions of ambient static pressure, the transmission behavior was found to be independent of the type of tissue used. Increase in static pressure up to +3 kPa caused maximum low frequency transmission loss of 15 dB when elastic grafts were used and 5 dB when stiff tissue was inserted. At high frequencies, measured loss of up to 5 dB was relatively independent of the tissue stiffness. Increase in static pressure led to displacement of the tissues towards the vestibulum and caused stiffening, especially of the annular ligament. Stiffening-induced transmission losses were mainly found at low frequencies and could not be compensated by the floating mass transducer in this range. Above 1300 Hz, the continuous force spectrum of the actuator sufficiently protected against loss of amplitude. To minimize postoperative transmission loss due to persisting ventilation disorders, choosing a very stiff tympanic membrane reconstruction material seems to be appropriate.

Pilot Study Assessing the Feasibility and Clinical Outcomes of Office-Based Ossiculoplasty.

OBJECTIVES:: The aim of this study was to assess the feasibility and safety of ossiculoplasty under local anesthesia in an office setting without sedation. METHODS:: Between May 2017 and November 2017, patients who presented with conductive hearing loss and known isolated ossicular discontinuities were offered ossiculoplasty under local anesthesia. Inclusion criteria included age ⩾ 18 years, adequate transcanal access, and the ability to lie supine for up to 45 minutes. Exclusion criteria included associated tympanic membrane perforation and the presence of middleear or mastoid cholesteatoma or infection. RESULTS:: Fourteen patients underwent the procedure. The mean age was 48.3 years (range, 19-74 years). Six were primary and 8 revision cases. There were 8 partial and 6 total prosthesis placements. The mean operative time was 34 minutes (range, 26-43 minutes). All patients tolerated the procedure to completion. There were no intraoperative complications. The mean air conduction pure-tone average was 76.6 dB and the mean bone conduction pure-tone average was 27.2 dB, with a preoperative air-bone gap of 49.9 dB. Air conduction pure-tone average significantly improved to 45.2 dB ( P < .0001). Air-bone gap significantly improved to 17.8 dB ( P < .0001). CONCLUSIONS:: Ossiculoplasty using partial or total prostheses can be safely performed in the office setting under local anesthesia without sedation in carefully selected patients. This has potentially significant patient and system benefits.

Titanium incus interposition ossiculoplasty: audiological outcomes and extrusion rates.

This study aimed to evaluate the benefit but also the extrusions, dislocations, and failures of a titanium incus prosthesis along with the long-term audiological outcomes. We prospectively collected data from 139 patients undergoing ossiculoplasty using the Fisch titanium incus prosthesis between 2001 and 2016. Overall, 126 patients with at least 6 months of follow-up (mean 4.5 years, range 6-155 months) were analyzed. Patients were grouped as "extrusion" (n = 9, 7%) if the prosthesis extruded, "failure" (n = 22, 18%) if a reoperation was needed concerning the prosthesis, and "stable" (n = 95, 75%) if the prosthesis remained functional in the middle ear. Mean postoperative air bone gaps (ABG) for 0.5-3 kHz for the overall group and the stable group were 19.8 (±11.9) and 15.3 (±7.5), respectively. Long-term results of stable group revealed an ABG (0.5-3 kHz) below 10 dB in 25% and below 20 dB in 81% of the patients. Atelectasis was the most frequent cause of extrusion, which occurred after a mean time of 28.7 months (range 15-48 months). Mean timing for reoperation was 30.7 months (range 5-131 months) in the failure group. There was no significant difference in mean postoperative ABG among patients with or without cholesteatoma, primary or staged ossiculoplasty in cholesteatoma, presence or absence of malleus head at the time of ossiculoplasty, open or closed cavity surgeries, or the degree of pneumatization of the temporal bone. The Fisch titanium incus prosthesis is a reliable alternative to using autologous incus for interposition ossiculoplasty, with similar hearing outcomes. Using this prosthesis, a 15 dB ABG should be expected.

[The application of the biologically compatible cyanacrylate-based glue for ossiculoplasty in the patients presenting with chronic otitis media]. / Primenenie biosovmestimogo kleya na osnove tsianakrilata pri ossikuloplastike u bol'nykh khronicheskim gnoinym srednim otitom.

The objective of the study was to improve the functional outcomes of the treatment in the patients presenting with chronic otitis media by means of the combined application of platelet-enriched plasma and the biologically compatible cyanacrylate-based glue for the fixation of the reconstructed auditory ossicular chain. The functional results of the surgery were evaluated within 1, 3, and12 months after the intervention making use of tonal threshold audiometry. It was shown that the use of the platelet-enriched plasma with its subsequent fixation by the biologically compatible cyanacrylate-based glue enhances stability of the implanted prosthetic elements, reduces the risk of their displacement during the postoperative period due to the formation of the cicatrical tissue between the structural components of the middle ear. This approach improves the functional result of the described treatment and decreases the frequency of relapses associated with poor stability of the reconstructed sound-conducting system.

Impact of Prosthesis Length on Tympanic Membrane's and Annular Ligament's Stiffness and the Resulting Middle Ear Sound Transmission.

HYPOTHESIS: Prosthesis' length creates tension in ossicular reconstructions, which directly effects the middle ear sound transmission. BACKGROUND: Relatively long prostheses are often used to stabilize the middle ear reconstruction to prevent dislocation. Thereby, tension on the flexible components such as the tympanic membrane (TM) and the annular ligament (AL) is increased. Only little is known on the amount of displacement-related stiffening of the TM and AL, as well as the consecutive reduction in middle ear transfer function (METF). METHODS: An expandable total ossicular replacement prosthesis was tensionfree inserted in nine cadaveric temporal bones between the malleus handle and the stapes footplate. Upon heat activation the prosthesis was lengthened, thus inducing tension on the reconstruction. The METF was assessed before and after elongation. TM's and AL's stiffness were determined by measuring their force-displacement characteristics. RESULTS: Upon activation the prostheses were elongated between 50 and 200 µm. A frequency-dependent METF reduction was measured with a decrease of 5 to 25 dB below 1.0 kHz. At frequencies >2.0 kHz the reduction was less prominent or the METF showed even an improvement of up to 10 dB. TM's stiffness remained constant during the elongation-induced displacement, whereas the AL's stiffness increased. The METF reduction below 1.0 kHz correlated with the increasing AL's stiffness. CONCLUSION: Tension has a significant impact on the METF after middle ear reconstruction. As little tension as possible should be used to enable best sound transmission. Stabilization of prosthesis should be achieved with dislocation devices to ensure secure coupling to the ossicular remnants without creating additional tension.

Hearing outcome after sequential cholesteatoma surgery.

The objective of this study was to assess hearing outcome after sequential cholesteatoma surgery stratified for exclusively transcanal technique (ETC), combined transcanal and transmastoidal technique (TCM) and canal wall down surgery (CWD) and to analyze the impact of ossicular reconstruction technique (partial ossicular replacement prostheses/PORP and total ossicular replacement prostheses/TORP) on hearing outcome. This study is a retrospective case review and clinical case study conducted in a tertiary referral center. Patients who underwent 376 cholesteatoma surgeries (2007-2009) and 92 ears in clinical re-examination at least 12 months postoperatively were included. Sequential cholesteatoma surgery with ETC, TCM, or CWD; ossiculoplasty with PORP or TORP were the interventions administered. Pre- and postoperative air-bone gap (ABG) and air conduction threshold (AC) for 0.5-3 kHz were the main outcome measures. Overall, the mean preoperative ABG decreased from 25.3 ± 1.3 to 19.8 ± 0.9 dB with a mean ABG closure of 5.4 ± 1.3 dB (p ≤ 0.001). According to surgical technique, the postoperative ABG after CWD 23.5 ± 2.1 was significantly worse compared to ETC (17.3 ± 1.0 dB, p < 0.05) and TCM (19.4 ± 1.3 dB). A significant ABG closure was observed after ETC (6.8 ± 2.0 dB, p < 0.01) and TCM (6.5 ± 2.0 dB, p < 0.01) contrary to CWD (2.1 ± 2.9 dB, p > 0.05). Patients receiving PORP showed a significantly less ABG postoperatively (19.0 ± 0.9 dB, p ≤ 0.05) compared to the TORP group (24.1 ± 2.5 dB). However, a significant hearing gain was assessed after PORP- (4.7 ± 1.6 dB, p ≤ 0.01) and TORP- implantation (10.4 ± 3.7 dB, p ≤ 0.01). Sequential cholesteatoma surgery allowed for an excellent hearing outcome postoperatively. An intact posterior canal wall and a present stapes suprastructure were identified to predict a significantly superior hearing result. In addition to the technical and prosthetic considerations, the audiological outcome was confounded by the attending middle ear pathology.

Revision stapes surgery for lysis of the long process of the incus: comparing hydroxyapatite bone cement versus malleovestibulopexy and total ossicular replacement prosthesis.

The objective of the study was to report audiological results in revision stapes surgery, comparing hydroxyapatite (HAP) bone cement, malleovestibular (MV) prosthesis, and total ossicular replacement prosthesis (TORP). The study is a retrospective case review conducted in a tertiary referral center. Patients treated for revision stapes surgery from 2010 to 2014, where a lysis of the long process of the incus (LPI) was observed with the use of HAP bone cement, MV prosthesis, or a TORP were included in the study. The main outcomes measured were pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3 kHz), including high frequencies BC (HFBC) (1, 2, 3, 4 kHz) and air-bone gap (ABG). 107 revision stapes surgery were performed in 96 ears. Main cause of failure was LPI lysis in 38 cases (39.6 %). 31 patients were analyzed: HAP bone cement was used in 11 patients (Group I), MV prosthesis in ten patients (Group II), and TORP in ten patients (Group III). The mean post-operative ABG was 10.7 dB (±7.4) (p = 0.003), 10.7 dB (±8.8) (p = 0.001), and 16.9 dB (±9.8) (p = 0.001), respectively. There were no significant differences between groups. In Group I, the mean change in HFBC revealed an improvement of 5.6 dB (±7.9) (p = 0.03), while in Group III there was a significant deterioration of the thresholds of 5.8 dB (±7.6) (p = 0.04). There were no cases of post-operative anacusis. In revision stapes surgery when LPI is eroded, we recommend to perform a cement ossiculoplasty for stabilizing a standard Teflon piston when LPI is still usable, the LPI lengthening with cement being not recommended. When LPI is too eroded, we prefer performing a malleovestibulopexy, and reserve TORP for cases with a bad anatomical presentation.

Use of the chorda tympani nerve in reconstruction of the ossicular chain.

We conducted a study to assess the use of the chorda tympani nerve in reconstruction of the ossicular chain. We retrospectively examined the medical records of 141 patients (154 ears) who had undergone middle ear surgery with 12 months of follow-up. The study population was made up of 58 males and 83 females, aged 9 to 83 years (mean: 45). These patients were divided into three groups based on the specific type of surgery they had undergone: in 35 patients, the chorda tympani nerve was used to spring and press the auricular bone prosthesis (CTN group); in 67 patients, the tympanic membrane was used to spring and press the auricular bone prosthesis (TM group); and in 39 patients, a gelatin sponge was used to support the auricular bone prosthesis (GS group). We compared pre- and postoperative air-bone gaps (ABGs) in each group, as well as the differences between these gaps among the three groups. We found significant differences between the pre- and postoperative ABGs in all three groups (all p < 0.01). These differences were also compared between the CTN and TM groups (t = 0.41; p > 0.05), between the CTN and GS groups (t = 2.07; p < 0.05), and between the TM and GS groups (t = 2.51; p < 0.05). In the CTN group, 1 patient experienced temporary postoperative hypogeusia, and another developed a mild case of delayed facial paralysis; both patients recovered within 2 weeks. We conclude that the chorda tympani nerve can be used to repair the ossicular chain to improve hearing without causing taste and facial nerve dysfunction and without the need for a second operation.

[The possibilities for the application of the fluoroplast-based prostheses with a diamond-like carbon nanocoating in ear surgery (an experimental study)].

The objective of the present study was to elucidate general and local characteristics of the tissue reactions to the implantation of radiation-modified polytetrafluoroethylene (PTFE)-based fluoroplast F-4PM20 with a diamond-like carbon (DLC) nanocoating or with the diamond-like carbon coating containing the dispersed nano-sized silver particles to the experimental animals (rats). A total of 150 inbred white rats were included into the experiment; they were divided into 3 groups comprised of 50 animals each. The rats in group 1 were implanted with the 5 nm thick strips of fluoroplast F-4PM20 having the diamond-like carbon nanocoating. The animals of group 2 were implanted with the same material containing nanoparticles of chemically pure silver dispersed in the coating, those in group 3 (controls) were implanted with the fluoroplast F-4PM20 without a coating. The animals were sacrificed on days 7, 21, 30, and 60 days after the onset of the experiment. The tissues surrounding the implant as well as heart, lung, spleen, liver, and kidney tissues were taken for the histological study. The local reactions of different tissues were found to be uniform even though there was an apparent tendency toward the less pronounced granulation and scarification processes in the animals implanted with the diamond-like carbon coating containing the dispersed nano-sized silver particles. In none of the groups, the animals exhibited statistically significant lymphoid tissue hyperplasia in the spleen which suggested the activation of the immune system in response to implantation. It is concluded that the PTFE-based fluoroplast F-4PM20 implants with the 5 nm thick DLC coating and a similar coating containing the dispersed nano-sized silver particles can be applied for middle ear reconstructive surgery, being a histologically compatible material that does not cause an inflammatory degenerative response of the tissues.

Clinical investigation of flat panel CT following middle ear reconstruction: a study of 107 patients.

OBJECTIVES: After middle ear reconstruction using partial or total ossicular replacement prostheses (PORP/TORP), an air-bone gap (ABG) may persist because of prosthesis displacement or malposition. So far, CT of the temporal bone has played the main role in the diagnosis of reasons for postoperative insufficient ABG improvement. Recent experimental and clinical studies have evaluated flat panel CT (fpCT) as an alternative imaging technique that provides images with high isovolumetric resolution, fewer metal-induced artefacts and lower irradiation doses. METHODS: One hundred and seven consecutive patients with chronic otitis media with or without cholesteatoma underwent reconstruction by PORP (n = 52) or TORP (n = 55). All subjects underwent preoperative and postoperative audiometric testing and postoperative fpCT. RESULTS: Statistical evaluation of all 107 patients as well as the sole sub-assembly groups (PORP or TORP) showed a highly significant correlation between hearing improvement and fpCT-determined prosthesis position. FpCT enables detailed postoperative information on patients with middle ear reconstruction. CONCLUSIONS: FpCT is a new imaging technique that provides immediate feedback on surgical results after reconstructive middle ear surgery. Specific parameters evaluated by fpCT may serve as a predictive tool for estimated postoperative hearing improvement. Therefore this imaging technique is suitable for postoperative quality control in reconstructive middle ear surgery. KEY POINTS: • Flat panel CT offers advantages with regard to artefacts and radiation dose. • FpCT provides higher isovolumetric resolution of temporal bone and middle ear implants. • FpCT allows prediction of the postoperative hearing outcome in patients. • FpCT is an important tool for immediate postoperative quality control. • FpCT improves postoperative management of patients with complications following ossicular replacement.

Subcutaneous emphysema and pneumolabyrinth plus pneumocephalus as complications of middle ear implant and cochlear implant surgery.

We conducted a retrospective case review at a tertiary academic medical center for the complications of pneumolabyrinth with pneumocephalus and subcutaneous emphysema after surgery for middle ear and cochlear implants. Charts of 76 cochlear implant and 2 middle ear implant patients from January 2001 through June 2009 were reviewed. We identified 1 cochlear implant recipient with pneumolabyrinth and pneumocephalus, and 1 middle ear implant recipient with subcutaneous emphysema. Surgical exploration was performed for the pneumolabyrinth with pneumocephalus; the subcutaneous emphysema was managed conservatively. The patient with the cochlear implant, who had had a ventriculoperitoneal shunt placed, experienced pneumolabyrinth with pneumocephalus 6 years after uneventful surgery. Middle ear exploration revealed no residual fibrous tissue seal at the cochleostomy. The middle ear and cochleostomy were obliterated with muscle, fat, and fibrin glue. The ventriculoperitoneal shunt was deactivated, with clinical and radiographic resolution. On postoperative day 5, the patient who had undergone the middle ear implant reported crepitance over the mastoid and implant device site after repeated Valsalva maneuvers. Computed tomography showed air surrounding the internal processor. A mastoid pressure dressing was applied and the subcutaneous emphysema resolved. These 2 cases support the importance of recognizing the clinical presentation of pneumolabyrinth with associated pneumocephalus, as well as subcutaneous emphysema. Securing the internal processor, adequately sealing the cochleostomy, and providing preoperative counseling regarding Valsalva maneuvers and the potential risk of cochlear implantation in the presence of a ventriculoperitoneal shunt may prevent adverse sequelae.

[A new method for the fixation of sound-conducting elements of the middle ear during ossiculoplasty].

The objective of the present work was to estimate the possibilities of the application of platelet-enriched plasma as a filtering material for ossiculoplasty. The results of surgical interventions on 120 patients presenting with chronic suppurative otitis media are reported. All the patients underwent closed-type sanation surgery (differential atticoanthrotomy) including either complete or partial restoration of the sound conduction mechanism in the middle ear. Platelet-enriched plasma was applied into the tympanic cavity of 55 patients as a fixing material for the reconstruction of the chain of the auditory ossicles. Ossiculoplasty without additional fixation was performed in 65 patients comprising the control group. The results of the study indicate that a clot of platelet-enriched plasma may be a good fixing material for the reconstruction of the entire chain of auditory ossicles and can be used for all types of ossiculopasty.

Esteem 2 middle ear implant: our experience.

INTRODUCTION: The Esteem is a totally implantable hearing system that uses piezoelectric technology. It is indicated in case of moderate to severe stable sensorineural hearing loss with a minimum discrimination score of 60% and a middle ear which is anatomically and functionally intact. Its two components (sensor and driver) are positioned and fixed in the mastoid cavity and coupled respectively to the incus body and capitulum with cement. STUDY DESIGN: Retrospective study. SETTINGS: Tertiary referral center. MATERIALS AND METHODS: Pure-tone average (PTA) gain in the implanted ear was calculated at 1, 2, and 4 KHz, word recognition score (WRS) gain at 50 dB SPL, and average WRS (AWRS) gain at 40, 55, and 70 dB SPL. WRS was also evaluated in silence and noise. All patients were asked to fill in the abbreviated profile of hearing aid benefit (APHAB) questionnaire pre- and postoperatively as well as an Esteem questionnaire. RESULTS: Thirteen patients received implants between May 2008 and April 2010. Five minor complications occurred (1 temporary partial facial palsy, 1 secondary healing difficulty, and 3 revision surgeries for poor and deteriorating functional results and progressive gain loss after use of a heart defibrillator). Two patients (15%) suffered major complications and their implants had to be removed 4 months postoperatively because of a Staphylococcus aureus wound infection. One patient underwent reimplantation 6 months later. Mean PTA gain was 25 ± 11 dB, mean WRS gain at 50 dB SPL was 64 ± 33%, and mean AWRS gain was 40 ± 20%. WRS in silence and with a signal-noise ratio of 10, 0, and -5 dB was 91 ± 11, 85 ± 14, 71 ± 19, and 64 ± 30%, respectively. The APHAB questionnaire revealed 84% of satisfaction improvement compared to the previous classic hearing aid. CONCLUSION: The totally implantable hearing device Esteem 2 can offer good functional and satisfaction results. Careful selection of patients is required, however, based on hearing tests, exclusion of middle ear ventilation problems, and CAT-scan middle ear anatomy. Specific surgical training and experience are also needed. The implant is safe and only associated with classic auditory implant complications.

A modified prosthesis head for middle ear titanium implants--experimental and first clinical results.

OBJECTIVE: An ossicular chain defect represents a challenging situation for otosurgeons. Despite modern reconstruction techniques, unsatisfying postoperative hearing results regularly occur. These are commonly caused by prosthesis dislocation. Whereas the reasons for prosthesis dysfunction occurring months or years after implantation are related to independent chronic conditions, early events of dislocations are more related to the technical fixation of the prosthesis inside the middle ear cavity. Consequently, a safe coupling between prosthesis head and tympanic membrane is essential for a successful type III tympanoplasty. Our study evaluated the use of a new prosthesis design with the aim to reduce short-term postoperative prosthesis dislocation in mind. STUDY DESIGN: Prospective experimental and clinical study. METHODS: A modified titanium total ossicular replacement prosthesis (TORP), whose head had spikes that extend into the cartilaginous neotympanic membrane, was designed and tested experimentally and then clinically. The lateral holding force of the new prosthesis head against lateral shift was measured and compared with common prosthesis heads without spikes. After proving this design experimentally, the prostheses were used intraoperatively in 35 tympanoplasty type III operations. Results were analyzed prospectively and compared with 35 retrospectively analyzed controls with conventional TORP prostheses. RESULTS: The lateral holding forces for the spike prosthesis heads were significantly higher (134 mN) than those for common prosthesis heads (92 mN) at a contact pressure of 100 mN. Postoperatively, pure-tone audiometry revealed satisfying hearing results. Spiked and conventional titanium TORPs yielded postoperative air-bone gaps (ABGs) of 20.9 and 18.6 dB with 54% and 57% ABG closure, within 20 dB, respectively. The air-bone gap was reduced by an average of 14 and 15 dB, respectively. However, these differences were not statistically significant. Both in the study and in the control group, no signs of prosthesis dislocation were discovered. CONCLUSION: The experimental data show that the new modified prosthesis head has an increased lateral holding force and thus reduces the risk of dislocation at the coupling side of the tympanic membrane. The postoperative hearing results are comparable to those of conventional prostheses. To confirm the advantage of the modified prosthesis plates over conventional prostheses, future studies with larger study populations are necessary.

BAHA: nueva incisión longitudinal con implante fuera de ésta / Baha: a new longitudinal incision with fixture out of the incision

Desde la introducción de las prótesis osteointegradas tipo BAHA (bone anchored hearing aid) hace unas décadas, su uso se ha generalizado por ser un método efectivo. Las complicaciones más frecuentes relacionadas con el BAHA son las dermatológicas, por lo que se han producido múltiples cambios en la técnica quirúrgica con el objetivo de disminuir su frecuencia. Hemos analizado el manejo de la piel y los tejidos blandos durante 8 años de experiencia con el BAHA. Presentamos una nueva incisión longitudinal con el implante situado fuera de ésta (AU)

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years experience with BAHA. We present a new longitudinal incision with the fixture out of the incision (AU)

Iatrogenic carotid artery pseudoaneurysm presenting with conductive hearing loss.

Pseudoaneurysms of the intracranial internal carotid artery may occur in the setting of carotid artery dehiscence, due to trauma, invasive tumors, or as a complication of surgery. The rare surgical complication of carotid artery laceration in the petrous segment may occur during myringotomy procedures, middle ear operations, or petrous temporal bone surgery. We report a 28-year-old female patient, a case of internal carotid artery pseudoaneurysm as a complication of middle ear surgery. On her follow-up, computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and a pseudoaneurysm involving the left petrous internal carotid artery was found in the cerebral angiography. She was managed by endovascular means.