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

Glen Knox, MD, Clinical Associate Professor of Otolaryngology at the University of Florida in Gainesville, pointed out that innovative designs of prostheses are also influencing the field, such as the SMart™ Stapes prosthesis, which uses nitinol, a nickel-titanium alloy that has the advantage of shape-memory. These prosthetics are not only useful for stapes surgery. For example, if a patient has an absent incus and stapes, the otolaryngologist now can use the shape-memory malleus-to-footplate prosthesis, he said. It’s useful for patients with surgery for middle ear disease in which ossicular reconstruction is needed. They are also useful in patients who have had a cholesteatoma that has involved more than one ossicle and have had the stapes removed. People will do staged reconstruction if the malleus is present, and in such cases, you can use this material to reconstruct the middle ear.

Dr. Knox believes that materials that have shape-memory properties will be used more and more. I certainly think that such materials will continue to be used in middle ear surgery for the foreseeable future, he said. He noted that, because the material conforms to the shape of the incus or malleus without crimping, there are fewer critical steps a surgeon has to perform. Therefore, shape-memory materials are easier to use. Materials that can be used as bone replacement are also important, he said.

However, he stressed that the innovative materials have not yet caused autologous prostheses or older materials to become obsolete. We are still using autologous methods, Dr. Knox said. If the incus bone is present, a sculpted incus malleus-to-footplate prosthesis can be constructed. In addition, hydroxyapatite is still being used, and diode laser soldering may become increasingly important in the future. Dr. Knox noted that another trend to watch is the research being conducted with implantable and semi-implantable hearing aids with the transducer attached to the ossicles.

The shape-memory methods in middle ear reconstruction, along with the wide use of other prosthetics, as well as implantable and semi-implantable hearing devices, will shape middle ear surgery in the near future, Dr. Knox said. These are the trends that are advancing middle ear reconstruction.

Although the field abounds with innovation, surgeons should not feel pressured to try them all, he observed. The appropriate new modalities to use depend on the surgeon’s preferences and experience, he said.

Key Trends in Middle Ear Reconstruction

The experts interviewed for this report identified several key trends in materials and procedures that are advancing middle ear reconstruction. They are summarized below.