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OSSICULOPLASTY

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OSSICULOPLASTY Analysis of Results Dr.Jerry Halik MD FRCSC N= 133 (Total-209) Age 5-71 Follow-up: up to 71 months(2 years average ... – PowerPoint PPT presentation

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Title: OSSICULOPLASTY


1
OSSICULOPLASTY
  • Analysis of Results
  • Dr.Jerry Halik MD FRCSC

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

3
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4
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5
Applebaum Incus Replacement Prosthesis(small)
  • N 28
  • Average age 41 years (18-67)
  • Average follow-up 20 months(1-76)

6
Applebaum Incus Replacement Prosthesis(small)-
Pre-op Diagnosis
  • Chronic Otitis Media 25(89)
  • Cholesteatoma 2
  • Trauma 1

7
Applebaum Incus Replacement Prosthesis(small)-Type
s of Repair
  • Ossiculoplasty12(43)
  • Ossiculoplasty with Tympanoplasty 14(50)
  • With canal wall down Mastoidectomy and
    Tympanoplasty2 (7)

8
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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10
Wehrs 2.7mm Incus Replacement Prosthesis
  • N29
  • Average age40 years(12-67)
  • Average follow-up19 months(1-77)

11
Wehrs 2.7mm Incus Replacement Prosthesis-Pre-op
Diagnosis
  • Chronic Otitis Media 15 (52)
  • Cholesteatoma 9 (31)
  • Malleus Head Fixation 5(17)

12
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)

13
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)
14
Wehrs 2.7mm Incus Replacement Prosthesis-Complica
tions
  • Hearing worse 3 (10)
  • Hyperacusis 1 (3)

15
Wehrs mm Incus-Stapes Replacement Prosthesis
  • N36
  • Average age34 years (5-67)
  • Average follow-up 25 months(1-66)

16
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17
Wehrs Incus-Stapes Replacement Prosthesis-
Pre-op Diagnosis
  • Chronic Otitis Media 16 (44)
  • Cholesteatoma 18 (50)
  • Congenital malformation2

18
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)

19
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)
20
Wehrs 2.7mm Incus-Stapes Replacement
Prosthesis-Complications
  • Hearing worse 1
  • Extrusion 1 (4 years)
  • Dislocation 1

21
Malleus-Stapes Assembly
  • N26
  • Average age 37 years (12-71)
  • Average follow-up22 months(1-63)

22
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23
Malleus-Stapes Assembly-Pre-op Diagnosis
  • Chronic Otitis Media 16 (62)
  • Cholesteatoma6 (23)
  • Trauma 1
  • Malleus Head Fixation 3

24
Malleus-Stapes Assembly-Types of Repair
  • Ossiculoplasty 12(46)
  • Ossiculoplasty with Tympanoplasty10(38)
  • With canal wall down Mastoidectomy and
    Tympanoplasty 4

25
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)
26
Malleus-Stapes Assembly-Complications
  • Worse Hearing 5(19)

27
Assemblies- Total (N119)
  • Pre-op diagnosis
  • Chronic Otitis Media 72(61)
  • Cholesteatoma35(29)
  • Trauma2
  • Malleus Head Fixation8
  • Congenital2

28
Assemblies-Types of repair
  • Ossiculoplasty 47 (39)
  • Ossiculoplasty with Tympanoplasty47(39)
  • Ossicuplasty withTympanoplasty and canal wall
    down Mastoidectomy 25(21)

29
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)
30
Assemblies-Complications
  • Hearing worse 8(7)
  • Hyperacusis 1
  • Extrusions 1
  • Dislocation 1

31
Torps and Porps
  • N14
  • Average age40 years.(4-65)
  • Average follow-up21 months(6-49)

32
Torps and Porps- Pre-op Diagnosis
  • Chronic otitis media8(57)
  • Cholesteatoma 4(29)
  • Congenital malformation 1
  • Malleus head fixation1

33
Torps and Porps- Types of Repair
  • Ossiculoplasty2
  • Ossiculoplasty with Tympanoplasty11(79)
  • With canal wall down Mastoidectomy and
    Tympanoplasty 1

34
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)
35
Torps and Porps Complications
  • Extrusion1(7)

36
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
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