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Hydroxylapatite middle ear implants: Clinical results
Otolaryngology Bead and Neck Surgery Volume 117 Number 2
cies than they were able to achieve with their aids. Because the soundbridge allows the patient's ear canal to remain open, their remaining natural hearing contributes to their positive results at the lower frequencies. The patients describe the sound produced by the soundbridge as being more natural than their hearing aids. They also state that there is significantly less noise produced by the soundbridge circuitry. 129
Hydroxylapatite Middle Ear Implants: Clinical Results ROBERT A. GOLDENBERG, MD, Dayton, Ohio
Objective: Hydroxylapatite has been widely used as a biomaterial for reconstruction of the hearing mechanism. This prospective study reports hearing results, extrusion rates, and surgical techniques for three different types of hydroxylapatite implants. Methods: Data from 398 consecutive cases of hearing reconstruction operated over a 6Tyear period were prospectively collected. Results of these cases, which used three different types of hydroxylapatite implants, were analyzed using appropriate statistical methodology. Personal surgical experience of the author was evaluated and condensed into critical points of surgical technique. Results: Hearing results were about the same for each of the three types of implants studied. Overall, 50% of all prostheses closed the air bone gap to within 2 0 d B (PTA 500, 1000, 2000, and 3000 Hz) regardless of the amount of pathology present. Better results were obtained with the incus and incus-stapes prostheses when the malleus was present; poorer results were found with the PORP and TORP designs. Extrusion rate was about 5%. Optimal technique of prosthesis placement depends upon precise measurement, perpendicular position and meticulous placement within the middle ear; the basic principle is a snug fit of the prosthesis without undue pressure into the oval window. Conclusions: Hydroxylapatite has proven itself as a biomaterial for ossicular reconstruction with satisfactory hearing results and a low extrusion rate. Refinements in implant design and surgical techniques have resulted in implants that are easy to use and readily available for a variety of reconstructive situations. 130
Pediatric Cochlear Implantation: Surgical Technique and Experience With the Clarion VINCENT N. CARRASCO, MD, and H A R O L D PILLSBURY, MD, Chapel Hill,N.C.
Objective: Clinical experience with pediatric cochlear implantation continues to grow. Much was learned about flap design, device fixation, and management of complications from early experience with the 3M House single channel and the Nucleus-22 channel implants. We will present
Scientific Posters
P201
our surgical technique for implantation of a new device in children: the Advanced Bionics ClarionTM. Methods: Experience is drawn from our pediatric implant database that contains over 115 children, 24 of whom are implanted with the ClarionTM. Included are two children with congenital inner ear abnormalities. Presented is flap design, bony well design including protecting bridge and gortex mesh securing technique. Results: There were no intraoperative or postoperative complications. Surgical management of cracked casings from impact injuries and explantation of extruded devices and replacement with the ClarionTM is presented. Conclusions: Twenty-three children were successfully implanted with this new device with excellent results. Successful replantation of extruded devices and replacement with the ClarionTM is an alternative to replantation with the same device and allows upgrade to this technology. Our technique produces an extremely low profile that protects the implant. 131
Treatment of Middle Ear Hypoventilation With a Subannular Tympanostomy Tube TIMOTHY O'HARE, MD, PhD, and JOEL A. GOEBEL, MD, St. Louis, Mo.
Objective: Chronic hypoventilation of the middle ear leads to a myriad of complications, such as adhesive otitis media, atrophic tympanic membranes, ossicular disruption, and failure when performing tympanoplasty. The main treatment for chronic middle ear hypoventilation is long-term ventilation. The trans-tympanic route is well known and accepted; however, at the time of tympanoplasty, this route may not be desirable or possible. Therefore we have developed a simple technique for insertion of a tube in a subannular position. We report on 11 patients who underwent insertion of an anteriorly placed subannular tube at the time of tympanoplasty. Methods: A series of 11 consecutive patients with the diagnosis of eustachian tube dysfunction (ETD) and/or adhesive otitis media and who underwent tympanoplasty alone or with ossiculoplasty or mastoidectomy were included in the study. Simultaneously a Goode T-tube was placed anteriorly in a subannular position that enters the protympanum. At routine follow-up we have assessed the position and patency of the T-tube, the presence and amount of tympanic membrane retraction, heating result, and complications. Results: There were 11 patients and ears that received a subannular tube. Nine ears had ETD, five had adhesive otitis media, and four had chronic suppurative otitis media. All patients had a conductive hearing loss (CHL.) and had prior surgery. Eight patients had multiple myringotomies and trans-tympanic typanostomy tubes. One patient failed two prior tympanoplasties. All patients underwent tympanoplasty; two also had a simple mastoidectomy, and seven patients also underwent ossiculoplasty. The mean followup is 4 months. All 11 patients have a patent tube that has not migrated or been extruded. Seventy percent of patients
cies than they were able to achieve with their aids. Because the soundbridge allows the patient's ear canal to remain open, their remaining natural hearing contributes to their positive results at the lower frequencies. The patients describe the sound produced by the soundbridge as being more natural than their hearing aids. They also state that there is significantly less noise produced by the soundbridge circuitry. 129
Hydroxylapatite Middle Ear Implants: Clinical Results ROBERT A. GOLDENBERG, MD, Dayton, Ohio
Objective: Hydroxylapatite has been widely used as a biomaterial for reconstruction of the hearing mechanism. This prospective study reports hearing results, extrusion rates, and surgical techniques for three different types of hydroxylapatite implants. Methods: Data from 398 consecutive cases of hearing reconstruction operated over a 6Tyear period were prospectively collected. Results of these cases, which used three different types of hydroxylapatite implants, were analyzed using appropriate statistical methodology. Personal surgical experience of the author was evaluated and condensed into critical points of surgical technique. Results: Hearing results were about the same for each of the three types of implants studied. Overall, 50% of all prostheses closed the air bone gap to within 2 0 d B (PTA 500, 1000, 2000, and 3000 Hz) regardless of the amount of pathology present. Better results were obtained with the incus and incus-stapes prostheses when the malleus was present; poorer results were found with the PORP and TORP designs. Extrusion rate was about 5%. Optimal technique of prosthesis placement depends upon precise measurement, perpendicular position and meticulous placement within the middle ear; the basic principle is a snug fit of the prosthesis without undue pressure into the oval window. Conclusions: Hydroxylapatite has proven itself as a biomaterial for ossicular reconstruction with satisfactory hearing results and a low extrusion rate. Refinements in implant design and surgical techniques have resulted in implants that are easy to use and readily available for a variety of reconstructive situations. 130
Pediatric Cochlear Implantation: Surgical Technique and Experience With the Clarion VINCENT N. CARRASCO, MD, and H A R O L D PILLSBURY, MD, Chapel Hill,N.C.
Objective: Clinical experience with pediatric cochlear implantation continues to grow. Much was learned about flap design, device fixation, and management of complications from early experience with the 3M House single channel and the Nucleus-22 channel implants. We will present
Scientific Posters
P201
our surgical technique for implantation of a new device in children: the Advanced Bionics ClarionTM. Methods: Experience is drawn from our pediatric implant database that contains over 115 children, 24 of whom are implanted with the ClarionTM. Included are two children with congenital inner ear abnormalities. Presented is flap design, bony well design including protecting bridge and gortex mesh securing technique. Results: There were no intraoperative or postoperative complications. Surgical management of cracked casings from impact injuries and explantation of extruded devices and replacement with the ClarionTM is presented. Conclusions: Twenty-three children were successfully implanted with this new device with excellent results. Successful replantation of extruded devices and replacement with the ClarionTM is an alternative to replantation with the same device and allows upgrade to this technology. Our technique produces an extremely low profile that protects the implant. 131
Treatment of Middle Ear Hypoventilation With a Subannular Tympanostomy Tube TIMOTHY O'HARE, MD, PhD, and JOEL A. GOEBEL, MD, St. Louis, Mo.
Objective: Chronic hypoventilation of the middle ear leads to a myriad of complications, such as adhesive otitis media, atrophic tympanic membranes, ossicular disruption, and failure when performing tympanoplasty. The main treatment for chronic middle ear hypoventilation is long-term ventilation. The trans-tympanic route is well known and accepted; however, at the time of tympanoplasty, this route may not be desirable or possible. Therefore we have developed a simple technique for insertion of a tube in a subannular position. We report on 11 patients who underwent insertion of an anteriorly placed subannular tube at the time of tympanoplasty. Methods: A series of 11 consecutive patients with the diagnosis of eustachian tube dysfunction (ETD) and/or adhesive otitis media and who underwent tympanoplasty alone or with ossiculoplasty or mastoidectomy were included in the study. Simultaneously a Goode T-tube was placed anteriorly in a subannular position that enters the protympanum. At routine follow-up we have assessed the position and patency of the T-tube, the presence and amount of tympanic membrane retraction, heating result, and complications. Results: There were 11 patients and ears that received a subannular tube. Nine ears had ETD, five had adhesive otitis media, and four had chronic suppurative otitis media. All patients had a conductive hearing loss (CHL.) and had prior surgery. Eight patients had multiple myringotomies and trans-tympanic typanostomy tubes. One patient failed two prior tympanoplasties. All patients underwent tympanoplasty; two also had a simple mastoidectomy, and seven patients also underwent ossiculoplasty. The mean followup is 4 months. All 11 patients have a patent tube that has not migrated or been extruded. Seventy percent of patients