Prosthetic Reconstruction from the Tympanic Membrane to the Stapes Head or to the Stapes Footplate? A Laser Doppler Study

• Background: In the absence of the incus, many surgeons believe that reconstruction from the tympanic membrane to the stapes head is more effective than reconstruction to the stapes footplate. This has rarely been tested empirically. Published better clinical results with reconstruction to the stapes head might simply reflect less underlying disease in ears with an intact stapes superstructure. Objective: To compare vibration transmission of these two forms of prosthetic reconstruction. Methods: A fresh human cadaveric temporal bone model was used. Round window vibrations in response to sound in the ear canal were measured with a laser Doppler vibrometer. After incus removal, the discontinuity was repaired using a titanium prosthesis. Reconstruction from the tympanic membrane to the stapes head was compared to reconstruction to the stapes footplate. Results: Reconstruction of both types decreased round window vibrations by 10 to 15 dB between 500 and 3000 Hz compared to the intact middle ear. Reconstruction to the stapes head performed 5 to 10 dB better at lower frequencies (500-2000 Hz), but this was only statistically significant at 1 and 2 kHz. Conclusions: There is only a 5 to 10 dB mechanical advantage gained by reconstruction from the tympanic membrane to the stapes head compared to reconstruction to the footplate for frequencies between 1 and 2 kHz.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Nyckelord

laser Doppler vibrometry

middle ear mechanics

ossiculoplasty

partial

ossicular replacement prosthesis

titanium prosthesis

total ossicular

replacement prosthesis

human middle-ear

ossicular chain reconstruction

malleus-to-footplate

intact stapes

temporal bone

ossiculoplasty

tympanoplasty

implants

model

torps

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)