New, Conforming, Easy-to-Use Materials Characterize Developments in Middle Ear Reconstruction

One reason that otolaryngologists have had a strong interest in titanium middle ear implants is titanium’s proven track record as an implant in other anatomical areas. As I talk with my colleagues throughout the country, I think my experience mirrors theirs, Dr. Lambert added. I think most people are very pleased with the properties in titanium that we are seeing.

Titanium implants are also being used in stapes replacement prostheses, Dr. Lambert said. However, because such patients usually have excellent surgical outcomes, it would be difficult to see a statistically significant impact that titanium has in that setting, he said.

Regarding the overall field of titanium implants, Dr. Lambert emphasized that otolaryngologists should temper the positive results with caution. With any middle ear prosthesis, it is prudent to evaluate long-term data, and long-term data for middle ear work should include a minimum follow-up of three years, with a follow-up of five to 10 years ideal.

Other newer prostheses include those that are designed for revision stapes surgery, Dr. Warren said. These prostheses are designed with angles that accommodate incus necrosis, the most common need for revision.4

Other materials that otolaryngologists are using for ossicular reconstruction outside of the stapes include hydroxyapatite cements and bone cement, he said.

Innovative Surgical Approaches

In addition to diode laser soldering, some investigators are using an erbium:YAG laser to perform stapedotomy, Dr. Warren said. The advantage of using this laser is that the surgeon can set the laser spot to a specific diameter to create the opening, he said. You don’t have to touch or put anything into the middle ear because the laser puts a hole into the footplate at the size designated by the surgeon, he said.

Posterior footplate repositioning is another innovative surgical approach, he said. Since the otosclerosis is in the anterior footplate, some are doing what they can to preserve the posterior aspect, he said. In this setting, the footplate is deliberately fractured and the posterior aspect is used as an autologous prosthesis. The hope is that using autologous middle ear bones will produce for more natural hearing, Dr. Warren said.

We’re using fewer incus homografts, primarily because of the quality of prostheses, he said. There’s no one thing that everyone’s doing because there are a lot of ways to skin a cat. In otolaryngology, we have a lot of well-trained people who do it a lot of different ways. There are more choices today than there were 10 years ago. This plethora of choices may make the decision of which prosthetic materials and which procedures to use more complicated. The innovations even extend to packing materials, he added, noting that a new hyaluronic gel is clear and allows for visualization of the implant after packing the ear, and it also decreases scar tissue in the ear.