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Ossicular Reconstruction | Clinical Gate

In patients with chronic otitis media causing hearing loss from ossicular chain damage, this study concluded that ossiculoplasty using an autologous incus as a grafting material was an effective and safe surgical method for reconstruction of the ossicular chain and restoration of sound transmission. A remolded autologous incus provided not only hearing restoration but also has a very low extrusion rate. The patient's incus is also readily available, cost effective and can be remolded according to the type of ossicular defect found in the patient.

Ossicular Chain Reconstruction - NWFace

Reconstruction of this type of ossicular discontinuity can be performed at the time of tympanoplasty surgery. There are several options. If the gap is small, it can be bridged by inserting a small piece of bone or cartilage taken from the patient at another site (behind the ear or from the lobe of tissue called the tragus in front of the ear). If there is a larger gap, then the incus bone is removed and modelled into a tooth-like prosthesis, using the operating microscope. This is then reinserted between the stapes and the malleus in order to reestablish continuity of the ossicular chain.

Ossicular Chain Reconstruction; ..

Other options include the insertion of a strut made out of an artificial bone, called hydroxy apatite. This artificial bone is porous and allows for the ingrowth of blood vessels and the complete assimilation of the artificial bone into the individual’s middle ear. With the modern day use of hydroxy apatite, there has been a marked reduction in the rejection of ossicular reconstruction prostheses.

The ear surgeon must decide whether the bones of hearing can be reconstructed at the time of the reconstruction of the ear drum. In most cases, this is possible if the ear is dry and not infected. The most common bone erosion occurs at the tip of the incus (anvil). This bone normally connects to the stapes (stirrup bone) and the connection is normally only 1.5 mm (1/24th of an inch–lead pencil’s lead width) in thickness. With prior infections, the circulation to the bone can become obstructed. Infection can gradually wear away the connection to the point where the bone is no longer in contact with the stapes bone. This is called ossicular discontinuity, a break in the bony connection. One can think of the incus as the player arm of a phonograph and the stapes as the needle. If the player arm is not in contact with the needle, sound will not be transmitted with the same force as it would with a good connection.

Total ossicular replacement prosthesis Surgery Video - …

In other less common ossicular reconstructions, the malleus (hammer) can become fixated by scar tissue or bony ingrowth to the lateral wall of the ear. In this "malleus fixation," the bone must be separated from the canal wall and remodeled. Silastic or a plastic type of sheeting is often placed against the wall to prevent regrowth of new bone. Reconstruction in this instance often requires that the stapes and incus be separated from their connection to stop the transmission of the drill’s vibration which would damage the inner ear.

If the bones of hearing are eroded, then ossicular reconstruction (reconstruction of the bones of hearing) may be necessary at the time of tympanoplasty. In some cases, this can be determined before the surgery. In other cases, it only becomes obvious at the time that the ear is completely opened and examined under the microscope.

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Bone-Cement Usage for Ossicular Reconstruction.

7. Desaulty A, Shahsavari S, Pasquesoone X. [Ossicular reconstruction with autograft in type III] Rev Laryngol Otol Rhinol (Bord). 2005;126(1):19-23. French.

Bone-Cement Usage for Ossicular Reconstruction

2. Smyth GD. Five-year report on partial ossicular replacement prostheses and total ossicular replacement prostheses. Otolaryngol Head Neck Surg 1982; 90(3 Pt 1):343–6.

ossicular chain reconstruction Case Number 2 * …

If ossicular reconstruction is necessary in the tympanoplasty, then an overnight stay is often recommended. There can be imbalance and dizziness immediately after this procedure. Dizziness is uncommon in operations that only involve the eardrum itself. Besides failure of the graft, there may be further hearing loss due to unexplained factors during the healing process. This occurs in less than five percent of individuals undergoing the operation.. A total hearing loss from tympanoplasty surgery is rare. This occurs in less than one percent of operations. Postoperative dizziness and imbalance can be present for about a week after surgery and are usually very mild. If the ear becomes infected postoperatively, the risk of dizziness increases. Generally, all imbalance and dizziness will be resolved after a week or two.

Ossicular Chain Reconstruction: One or Two Bones



Taking the three levers together, the middle ear offers a theoretical gain of approximately 34 dB.

OSSICULAR COUPLING

Ossicular coupling refers to the true sound pressure gain that occurs through the actions of the tympanic membrane and the ossicular chain.

The mean middle ear gain is approximately 20 dB at 250 to 500 Hz, reaches a maximum of about 25 dB around 1 kHz, and then decreases at about 6 dB per octave at frequencies above 1 kHz.8

portions of the tympanic membrane vibration

slippage of the ossicular chain

middle ear space


PROSTHESIS OPTIONS
The ideal material for ossicular reconstruction should meet three principal criteria.

Ossicular Chain Reconstruction | Head and Neck …

Work in developing superior implant materials was continued until the 1970’s, when bioactive materials were developed. Their name comes from their chemical structure, which promotes chemical adhesion between the tissue and the implant, effectively eliminating the need for Auto- and Homo- Grafts.

From 1970 to up till now, various types of material have been using for ossicular chain reconstruction like as Gold, Stainless Steel, Platinum, Hydroxyapatite, Teflon, Polyethylene, Glass Ionomer Cement, and Titanium.

But recently the new trend starts to perform surgery of Ossiculoplasty, Stapedioplasty, and Myringoplasty with based Middle ear` implants. Titanium implants are extensively used in cardiovascular, spinal surgery, orthopedic and dental surgery as well as in reconstructive and plastic surgery.






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