Results with titanium ossicular reconstruction prostheses

Objectives/Hypothesis: Despite the enthusiasm of recent short-term reviews, no center in the United States has published results meeting American Academy of Otolaryngology-Head and Neck Surgery guidelines with titanium-based prostheses. The purpose of the study was threefold. The first purpose was to review results with a titanium prosthesis system in,cases meeting American Academy of Otolaryngology-Head and Neck Surgery reporting guidelines. The second was to compare these results with previously published results using non-titanium-based prostheses. The third was to examine the authors' results for any evidence of a "learning curve." Study Design: Retrospective chart review was performed for the period from February 2000 to August 2001 and for the period from July 2002 to February 2003. Methods. Of 313 cases, 130 consecutive cases were identified in the first period and 65 in the second time period. One hundred two patients had adequate follow-up for published guidelines. All cases were performed by the senior author (C.G.J.). Comparison data were obtained from a previous publication involving the senior author. Results. Successful rehabilitation (520 dB pure-tone average air-bone gap) of conductive hearing loss was obtained in 70% of partial ossicular chain reconstructions and 44% of total ossicular chain reconstructions when titanium prostheses were used. Comparison data revealed successful rehabilitation in 48% and 21% of non-titanium-based partial and total reconstructions, respectively. Postoperative pure-tone average air-bone gaps were not significantly different when compared with results in the period from July 2002 to February 2003. Conclusion: Newer titanium-based ossicular reconstruction devices represent an improvement over previously used non-titanium-based prostheses. The authors think that this improvement is realized rapidly because no learning curve existed in their data.