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

Materials

• Titanium: this biocompatible material, which has been used for several years for implants in several anatomical areas of the body, has also been identified as useful in middle ear reconstruction. Titanium implants are lightweight, easy for surgeons to position, nonreactive to ferromagnetism (and therefore do not complicate MRI), and stable, with a low incidence of extrusion. Companies manufacturing titanium implants include the German company Stryker Leibinger Co.
• Shape-memory: These fluoroplastic materials are characterized by their ability to soften in contact with body heat and conform to the individual’s middle ear structures. One example is the SMart™ Stapes, manufactured by Gyrus ENT (formerly Richards Medical Company).
• Hydroxyapatite: Although used in prostheses for several years, hydroxyapatite still has utility as a material for middle ear prostheses. Several companies manufacture hydroxyapatite middle ear prostheses.
• Autologous bone: Autologous bone, particularly the incus and the posterior aspect of the stapes, is often used in cases where the anterior component is absent.

Laser Procedures

• Diode laser: The diode laser is used to solder the implant to the anatomical junctions that it bridges. Diode laser soldering is still investigational.
• Carbon dioxide laser: The CO₂ laser is used in middle ear surgery as a way to make a stapedotomy that is the precise size that the surgeon needs. It provides a hands-off way to perform stapedotomy with uniform results.

Other Intraoperative Materials

• Transparent hyaluronic gel: This material has the advantage of allowing visualization of the implant after the surgeon has packed the ear. It is manufactured by Genzyme under the name Sepragel.

References

1. Rosowski JJ, Merchant SN. Mechanical and acoustic analysis of middle ear reconstruction. Am J Otol 1995;16(4):486-97.

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2. Khan I, Jan AM, Shahzad F. Middle ear reconstruction: a review of 150 cases. J Laryng Otol 2002;116(6):435-9.

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3. Ditkoff M et al. Potential use of diode laser soldering in middle ear reconstruction. Lasers Surg Med 2002;31(4):242-6.

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4. Gardner EK, Jackson CG, Kaylie DM. Results with titanium ossicular reconstruction prostheses. Laryngoscope 2004 Jan;114(1):65-70.

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