A NEW PROSTHESIS FOR RECONSTRUCTING THE INCUDOSTAPEDIAL JOINT

Objective: This study aimed to evaluate the hearing results obtained u sing the Silverstein incus-Stapes Connection in ossicular reconstructi on among patients with chronic ear disease. Study Design: The study wa s performed as a retrospective review. A control group consisted of pa tients undergoing similar surgery but in which no prosthesis was used. Setting: The Florida Ear and Sinus Center outpatient offices of the s enior author. Patients: Forty-seven patients with a mean age of 48 yea rs comprised the treatment group. Thirty-eight patients (mean age, 49. 4 years) acted as control subjects. Intervention: All patients underwe nt surgery for chronic ear disease. Reconstruction surgery for patient s requiring separation of the incudostapedial was performed with a Sil verstein Incus-Stapes Connection or by reapproximating the joint capsu le to allow primary healing. Main Outcome Measure: The patients were c ategorized according to how the prosthesis was used. Results comparing the preoperative air-bone gap and postoperative air-bone gap were eva luated. The change in air-bone gap was reported according to the guide lines set forth by the Committee an Hearing and Equilibrium. Results: The mean postoperative air-bone gap for reconstruction with the prosth esis was 17.6 dB compared to a mean of 11.8 dB among control subjects. An air-bone gap of 16.5 dB was achieved when the prosthesis was used to bridge an area of lenticular resorption. When a composite prosthesi s, made by adding cartilage to the disk, was used to bridge larger def ects, an air-bone gap of 14.3 dB was seen. Finally, when the prosthesi s was used as a partial ossicular replacement prosthesis and directly contacted the tympanic membrane, the air-bone gap was 9 dB. The prosth esis was found to be stable when re-exploration was required and modif ication of the prosthesis with cartilage was accomplished easily intra operatively. Conclusion: The Silverstein Incus-Stapes Connection is a middle ear prosthesis that can provide a mechanism for overcoming incu s resorption in selected cases. In addition, the prosthesis can be mod ified easily with the addition of cartilage when needed.