Titanium clip piston versus platinum-ribbon Teflon piston: Piston and fenestra size affect air-bone gap

Objective: To analyze if titanium material and a clip attachment to the incus offer a hearing result advantage over the traditional Teflon piston in stapes surgery. Study Design: Retrospective chart review. Setting: Subspecialty private practice. Patients: One hundred seven ears in 97 consecutive patients who had primary stapes surgery during 2003 to 2005. Intervention: The first 74 ears received either a Teflon 0.5- or 0.6-mm piston, and the last 33 received a titanium 0.6-mm piston. Main Outcome Measures: American Academy of Otolaryngology-Head and Neck Surgery guidelines, including 4-frequency pure-tone average air-bone gap and success rate (gap, 10 dB). Results: Mean pure-tone average air-bone gap for the Teflon 0.6-mm piston (5.1 dB) was significantly smaller than for the titanium 0.6-mm piston (8.1 dB) and the Teflon 0.5-mm piston (7.5 dB). Success rate did not differ. Although labeled as 0.6-mm pistons, the Teflon piston diameter was 10% greater than the titanium piston. Results were comparable among devices when adjusted for true piston diameter. Results for the titanium piston were significantly better when the fenestra was no more than 0.05 mm larger than the piston diameter. Conclusion: Comparing 2 pistons designated 0.6 mm in diameter, the Teflon piston produced better hearing results than the titanium device. However, actual piston diameter differed between devices that contributed to the superior results with the larger Teflon piston. In addition, the titanium piston performed better with a small stapes fenestra diameter that suggests an advantage for titanium over Teflon in certain conditions. The clip design was problematic for a few patients.