gms | German Medical Science

Introduction: To present the preliminary results of a new malleus replacement prosthesis combined with a total ossicular prosthesis in middle ear reconstruction in patients missing the malleus and stapes.

Methods: An original titanium malleus replacement prosthesis (MRP), was designed to be inserted into the external auditory canal and to replace a missing malleus for various middle ear pathologies. Ninety patients with missing malleus and stapes, undergoing 92 ossicular reconstructions were enrolled in this study from September 1994 to March 2012. Comparative analyses were made between a group of 34 cases of ossicular reconstructions with total prosthesis (TORP) positioned from the tympanic membrane to the stapes footplate (TM-to-footplate assembly) and a group of 58 cases of ossicular reconstructions with TORP positioned from a newly designed malleus replacement prosthesis (MRP) to the stapes footplate (MRP-to-footplate assembly). Preoperative and postoperative audiometric evaluation using conventional audiometry were assessed.

Results: In the TM-to-footplate group the 3-month postoperative mean ABG was 23.3 dB compared to 12.5 dB in the MRP-to-footplate group. 37.0% of patients from the TM-to-footplate group had a postoperative ABG of 10 dB or less and 48.1% of patients had a postoperative ABG of 20 dB or less, as compared to 58.1% and 79.1% respectively in the MRP-to-footplate group. The average gain in AC was 11.0 dB in the TM-to-footplate group as compared to 21.3 dB in the MRP-to-footplate group

Conclusion: Superior postoperative hearing thresholds could be achieved using a MRP-to-footplate assembly, compared to a TM-to-footplate assembly in patients with an absent malleus undergoing ossiculoplasty.

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