OSSICULOPLASTY

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OSSICULOPLASTY

• Analysis of Results
• Dr.Jerry Halik MD FRCSC

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

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Applebaum Incus Replacement Prosthesis(small)

• N 28
• Average age 41 years (18-67)
• Average follow-up 20 months(1-76)

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Applebaum Incus Replacement Prosthesis(small)-
Pre-op Diagnosis

• Chronic Otitis Media 25(89)
• Cholesteatoma 2
• Trauma 1

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Applebaum Incus Replacement Prosthesis(small)-Type
s of Repair

• Ossiculoplasty12(43)
• Ossiculoplasty with Tympanoplasty 14(50)
• With canal wall down Mastoidectomy and
  Tympanoplasty2 (7)

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Applebaum Incus Replacement Prosthesis(small)-Resu
ltsA-B closurePossible SRTlt30 db23 post op
SRT lt30dB15/23(65)
0.5,1,2kHz 0.5,1,2,4kHz
lt 10dB 11/28 (39) 9/28 (32)
lt20dB 11/28 (39) 10/28 (36)
Total 22/28 (78) 19/28 (68)
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Wehrs 2.7mm Incus Replacement Prosthesis

• N29
• Average age40 years(12-67)
• Average follow-up19 months(1-77)

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Wehrs 2.7mm Incus Replacement Prosthesis-Pre-op
Diagnosis

• Chronic Otitis Media 15 (52)
• Cholesteatoma 9 (31)
• Malleus Head Fixation 5(17)

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Wehrs 2.7mm Incus Replacement Prosthesis- Types
of Repair

• Ossiculoplasty12 (41)
• Ossiculoplasty with Tympanoplasty 10(34)
• With canal wall down Mastoidectomy and
  Tympanoplasty 7(24)

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Wehrs 2.7mm Incus Replacement Prosthesis-Results
possible SRTlt30db25 Post op
SRTlt 30dB13/25(52)A-B Closure
0.5,1,2kHz 0.5,1,2,4kHz
lt10dB 10/29 (34) 9/29(31)
lt20dB 11/29(38) 12/29(41)
Total 21/29(72) 21/29(72)
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Wehrs 2.7mm Incus Replacement Prosthesis-Complica
tions

• Hearing worse 3 (10)
• Hyperacusis 1 (3)

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Wehrs mm Incus-Stapes Replacement Prosthesis

• N36
• Average age34 years (5-67)
• Average follow-up 25 months(1-66)

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Wehrs Incus-Stapes Replacement Prosthesis-
Pre-op Diagnosis

• Chronic Otitis Media 16 (44)
• Cholesteatoma 18 (50)
• Congenital malformation2

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Wehrs 2.7mm Incus-Stapes Replacement
Prosthesis-Type of repair

• Ossiculoplasty 11(31)
• Ossiculoplasty with Tympanoplasty13(36)
• With canal wall down Mastoidectomy and
  Tympanoplasty 12(33)

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Wehrs Incus-Stapes Replacement Prosthesis-
Resultspossible
SRTlt30db32 Post op SRTlt
30dB19/32(59)A-B Gap Closure 1
overclosure
0.5,1,2kHz 0.5,1,2,4kHz
lt10dB 16/36(44) 11/36(31)
lt20dB 10/36(28) 12/36(33)
Total 26/36(72) 23/36(64)
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Wehrs 2.7mm Incus-Stapes Replacement
Prosthesis-Complications

• Hearing worse 1
• Extrusion 1 (4 years)
• Dislocation 1

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Malleus-Stapes Assembly

• N26
• Average age 37 years (12-71)
• Average follow-up22 months(1-63)

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Malleus-Stapes Assembly-Pre-op Diagnosis

• Chronic Otitis Media 16 (62)
• Cholesteatoma6 (23)
• Trauma 1
• Malleus Head Fixation 3

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Malleus-Stapes Assembly-Types of Repair

• Ossiculoplasty 12(46)
• Ossiculoplasty with Tympanoplasty10(38)
• With canal wall down Mastoidectomy and
  Tympanoplasty 4

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Malleus-Stapes Assembly-ResultsA-B gap closure
Possible SRTlt30dB 22 Post-op SRtlt30dB 11/22
(50)
0.5,1,2kHz 0.5,1,2,4kHz
lt10dB 3/26(12) 2/26(8)
lt20dB 8/26(31) 10/26(38)
Total 11/26(42) 12/26(46)
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Malleus-Stapes Assembly-Complications

• Worse Hearing 5(19)

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Assemblies- Total (N119)

• Pre-op diagnosis
• Chronic Otitis Media 72(61)
• Cholesteatoma35(29)
• Trauma2
• Malleus Head Fixation8
• Congenital2

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Assemblies-Types of repair

• Ossiculoplasty 47 (39)
• Ossiculoplasty with Tympanoplasty47(39)
• Ossicuplasty withTympanoplasty and canal wall
  down Mastoidectomy 25(21)

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Assemblies-ResultsA-B gap closurepossible
SRTlt30dB102 Post oplt30dB58/102(57) 1
overclosure
0.5,1,2kHz 0.5,1,2,4kHz
lt10dB 40/119(34) 31/119(76)
lt20dB 40/119(34) 44/119(37)
Total 80/119(68) 75/119(63)
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Assemblies-Complications

• Hearing worse 8(7)
• Hyperacusis 1
• Extrusions 1
• Dislocation 1

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Torps and Porps

• N14
• Average age40 years.(4-65)
• Average follow-up21 months(6-49)

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Torps and Porps- Pre-op Diagnosis

• Chronic otitis media8(57)
• Cholesteatoma 4(29)
• Congenital malformation 1
• Malleus head fixation1

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Torps and Porps- Types of Repair

• Ossiculoplasty2
• Ossiculoplasty with Tympanoplasty11(79)
• With canal wall down Mastoidectomy and
  Tympanoplasty 1

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Torps and Porps- Results A-B gap
closurepossible Satlt30dB12 Post op
Satlt30dB4/12(25)
0.5,1,2kHz 0.5,1,2,4kHz
lt10dB 2/14(14) 1/14(7)
lt20dB 6/14(43) 5/14(36)
Total 8/14(57) 6/14(43)
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Torps and Porps Complications

• Extrusion1(7)

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Conclusions

• Assemblies better than torps and porps(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