KBB-Forum 2005 , Cilt 4, Sayı 4


Levent OLGUN, MD; Tolga KANDOĞAN, MD; Gürol GÜLTEKİN, MD; Güldeniz GÜLER, MD; Uğur ÇERÇİ, MD
İzmir Eğitim ve Araştırma Hastanesi, KBB, İzmir, Türkiye In this report, results of the applications of titanium-gold total ossicular replacement prosthesis are presented and they are compared with other types of prosthesis used in clinical practice.

Material & Method
This study was performed on 24 patients, 14 male and 10 female, aged between 13 to 67. In all patients, primary pathology was chronic cholesteatomatous otitis media, and none of them were revision cases. In all cases, canal wall down technique tympanoplasty type 3 was performed with titanium-gold prosthesis. A thin block of conchal cartilage was put over the plate of the prosthesis and ear drum was reconstructed with autograft temporalis muscle fascia in all cases. The control group consisted of 30 patients operated for same middle ear pathology. In these cases, surgeries were similar except the prostheses that have been used. In this group, in seven of patients pure hydroxyapatite TORP`s were used; in the rest, the choice was a hydroxyapatite polyethilen hybrid prosthesis. An average air-bone gap for all calculated frequencies of 0.5, 1, and 2 kHz was investigated in study and control groups. Statistical analysis is performed using Independent-Samples T Test.

There was no statistically significant difference in post-operative hearing gain between control and study groups. In the study group all but two tympanic membrane healed well, in 22 cases, the prostheses remained stable. Only in one case the slipage of the cartilage cover caused a partial show up of prosthesis without extrusion at fourth mounth. In one out of 30 patients in control group, the grafts were intact up to 1 year, and in one case, extrusion of the hydroxyapatite TORP was seen. When the air-bone gap "gold standard" (i.e., < or =10 dB) was investigated in the main speech spectrum, 2 patients from the study group and 2 patients from the control group had post-operative air-bone gap < or =10 dB. An average air-bone gap between 11-20 dB was achieved in 19 patients in study group and in 21 patients in control group. A post-operative air-bone gap between 21-30 dB was achieved in 3 patients in study group and in 6 patients in control group. In one case in the control group, hearing was deteriorated.

Initial evaluation of the titanium-gold prostheses produced low extrusion rates with acceptable hearing results. We have found this prosthesis as successful as hydroxyapatite and hydroxyapatite hybrid prostheses, when used in a similar situations. Keywords : Titanium-gold total ossicular replacement prosthesis, tympanoplasty, chronic otitis media