Ossicular Chain Reconstruction Using Titanium versus Hydroxyapatite Implants

Objectives. Compare the efficacy of total and partial ossicular chain reconstruction using hydroxyapatite (HA) implants versus titanium (Ti) implants. Design. Case series with chart review. Setting. Academic tertiary referral center and private practice. Subjects and Methods. 404 patients underwent ossiculoplasty using either Ti or HA implants from June 1996 to September 2008. Patient data were collected retrospectively from the senior author's electronic database of surgical cases. Results. The change in air-bone gap (Delta ABG) (defined as the difference between the means of preoperative and postoperative ABG) was 9.9 dB for the HA group that received partial ossicular reconstruction prosthesis (PORP), 9.5 dB for the Ti PORP group, 12.3 dB for the Ti group that received total ossicular reconstruction prosthesis (TORP), and 10.0 dB for the HA TORP group. There was no statistically significant difference between the HA and Ti groups. There was no significant difference in hearing results between canal wall up (CWU) and canal wall down (CWD) cases in which mastoidectomy was performed. Four confounding factors (preoperative otorrhea, preoperative perforation, cholesteatoma, mastoidectomy performed) were analyzed using regression analysis. In the Ti PORP group, the presence of cholesteatoma was found to have a significant negative bias for hearing results. Conclusion. No statistically significant differences in hearing results were found between the HA and the Ti partial and total ossiculoplasty prostheses. No outcome difference was found between CWU versus CWD mastoidectomy groups for any type of implant used. A randomized, prospective study is necessary for a more definitive comparison of efficacy between HA and Ti OCR implants.