Analysis of Results Dr.Jerry Halik MD FRCSC

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Presentation transcript:

Analysis of Results Dr.Jerry Halik MD FRCSC OSSICULOPLASTY Analysis of Results Dr.Jerry Halik MD FRCSC

N= 133 (Total-209) Age 5-71 Follow-up: up to 71 months(2 years average)

Applebaum Incus Replacement Prosthesis(small) Average age: 41 years (18-67) Average follow-up: 20 months(1-76)

Applebaum Incus Replacement Prosthesis(small)- Pre-op Diagnosis Chronic Otitis Media : 25(89%) Cholesteatoma : 2 Trauma : 1

Applebaum Incus Replacement Prosthesis(small)-Types of Repair Ossiculoplasty:12(43%) Ossiculoplasty with Tympanoplasty :14(50%) With canal wall down Mastoidectomy and Tympanoplasty:2 (7%)

Applebaum Incus Replacement Prosthesis(small)-Results A-B closure Possible SRT<30 db:23 post op SRT <30dB:15/23(65%) 0.5,1,2kHz 0.5,1,2,4kHz < 10dB 11/28 (39%) 9/28 (32%) <20dB 10/28 (36%) Total 22/28 (78%) 19/28 (68%)

Wehr’s 2.7mm Incus Replacement Prosthesis Average age:40 years(12-67) Average follow-up:19 months(1-77)

Wehr’s 2.7mm Incus Replacement Prosthesis-Pre-op Diagnosis Chronic Otitis Media: 15 (52%) Cholesteatoma: 9 (31%) Malleus Head Fixation : 5(17%)

Wehr’s 2.7mm Incus Replacement Prosthesis- Types of Repair Ossiculoplasty:12 (41%) Ossiculoplasty with Tympanoplasty: 10(34%) With canal wall down Mastoidectomy and Tympanoplasty: 7(24%)

Wehr’s 2.7mm Incus Replacement Prosthesis-Results possible SRT<30db:25 Post op SRT< 30dB:13/25(52%) A-B Closure 0.5,1,2kHz 0.5,1,2,4kHz <10dB 10/29 (34%) 9/29(31%) <20dB 11/29(38%) 12/29(41%) Total 21/29(72%)

Wehr’s 2.7mm Incus Replacement Prosthesis-Complications Hearing worse: 3 (10%) Hyperacusis: 1 (3%)

Wehr’s mm Incus-Stapes Replacement Prosthesis Average age:34 years (5-67) Average follow-up : 25 months(1-66)

Wehr’s Incus-Stapes Replacement Prosthesis- Pre-op Diagnosis Chronic Otitis Media : 16 (44%) Cholesteatoma: 18 (50%) Congenital malformation:2

Wehr’s 2.7mm Incus-Stapes Replacement Prosthesis-Type of repair Ossiculoplasty: 11(31%) Ossiculoplasty with Tympanoplasty:13(36%) With canal wall down Mastoidectomy and Tympanoplasty : 12(33%)

Wehr’s Incus-Stapes Replacement Prosthesis- Results possible SRT<30db:32 Post op SRT< 30dB:19/32(59%) A-B Gap Closure * 1 overclosure 0.5,1,2kHz 0.5,1,2,4kHz <10dB 16/36(44%) 11/36(31%) <20dB 10/36(28%) 12/36(33%) Total 26/36(72%) 23/36(64%)

Wehr’s 2.7mm Incus-Stapes Replacement Prosthesis-Complications Hearing worse: 1 Extrusion: 1 (4 years) Dislocation: 1

Malleus-Stapes Assembly N=26 Average age : 37 years (12-71) Average follow-up:22 months(1-63)

Malleus-Stapes Assembly-Pre-op Diagnosis Chronic Otitis Media: 16 (62%) Cholesteatoma:6 (23%) Trauma: 1 Malleus Head Fixation: 3

Malleus-Stapes Assembly-Types of Repair Ossiculoplasty: 12(46%) Ossiculoplasty with Tympanoplasty:10(38%) With canal wall down Mastoidectomy and Tympanoplasty: 4

Malleus-Stapes Assembly-Results A-B gap closure Possible SRT<30dB :22 Post-op SRt<30dB: 11/22 (50%) 0.5,1,2kHz 0.5,1,2,4kHz <10dB 3/26(12%) 2/26(8%) <20dB 8/26(31%) 10/26(38%) Total 11/26(42%) 12/26(46%)

Malleus-Stapes Assembly-Complications Worse Hearing: 5(19%)

Assemblies- Total (N=119) Pre-op diagnosis Chronic Otitis Media: 72(61%) Cholesteatoma:35(29%) Trauma:2 Malleus Head Fixation:8 Congenital:2

Assemblies-Types of repair Ossiculoplasty: 47 (39%) Ossiculoplasty with Tympanoplasty:47(39%) Ossicuplasty withTympanoplasty and canal wall down Mastoidectomy: 25(21%)

Assemblies-Results A-B gap closure possible SRT<30dB:102 Post op<30dB:58/102(57%) * 1 overclosure 0.5,1,2kHz 0.5,1,2,4kHz <10dB 40/119(34%) 31/119(76%) <20dB 44/119(37%) Total 80/119(68%) 75/119(63%)

Assemblies-Complications Hearing worse: 8(7%) Hyperacusis: 1 Extrusions: 1 Dislocation: 1

Torps and Porps N=14 Average age:40 years.(4-65) Average follow-up:21 months(6-49)

Torps and Porps- Pre-op Diagnosis Chronic otitis media:8(57%) Cholesteatoma: 4(29%) Congenital malformation: 1 Malleus head fixation:1

Torps and Porps- Types of Repair Ossiculoplasty:2 Ossiculoplasty with Tympanoplasty:11(79%) With canal wall down Mastoidectomy and Tympanoplasty : 1

Torps and Porps- Results A-B gap closure possible Sat<30dB:12 Post op Sat<30dB:4/12(25%) 0.5,1,2kHz 0.5,1,2,4kHz <10dB 2/14(14%) 1/14(7%) <20dB 6/14(43%) 5/14(36%) Total 8/14(57%)

Torps and Porps: Complications Extrusion:1(7%)

Conclusions Assemblies better than torp’s and porp’s(60% vs 25% success) ?Effectiveness of malleus-stapes assembly ?which prosthesis Safe Long term results problematic Single stage procedures reasonable ?Cost effective ?Use of aids after failure