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Ossicular Prosthesis
Bronwyn E. Hamilton, MD; H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Synonyms

          • Ossicular replacement prosthesis (ORP)
        • Definitions

          • Ossiculoplasty: Surgical reconstruction of malfunctioned part of ossicular chain (OC) to improve or maintain conductive hearing function
          • Materials: Allograft > autograft > > homograft
            • Allograft: Synthetic ossicular replacements (titanium)
            • Autograft: Patient's own ossicle used
            • Homograft: Radiated, frozen human ossicles
              • Homograft use ↓ ↓ in 1990s over concern of risk for disease transmission (e.g., AIDS)
            • Autologous: Patient's own pinna cortical bone and cartilage
              • Newest entry into ORP mix
        • 4 Common Ossicular Replacement Prosthesis Types

          • Stapes prosthesis
          • Incus interposition graft
          • Partial ORP (PORP)
          • Total ORP (TORP)

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Gross Pathologic & Surgical Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Schwartz TR et al: Gray-scale inversion on high resolution computed tomography of the temporal bone: an observational study. Ann Otol Rhinol Laryngol. 130(10):1125-31, 2021
                                  2. Senturk E et al: Stapedectomy in patients with dehiscent and prolapsed facial nerve. Am J Otolaryngol. 41(5):102580, 2020
                                  3. Gosselin E et al: Predictable prosthesis length on a high-resolution CT scan before a stapedotomy. Eur Arch Otorhinolaryngol. 275(9):2219-26, 2018
                                  4. Hirsch JD et al: Surgical reconstruction of the ossicular chain with custom 3D printed ossicular prosthesis. 3D Print Med. 3(1):7, 2017
                                  5. Fang Y et al: MPR-CT imaging for stapes prosthesis: accuracy and clinical significance. Otol Neurotol. 37(4):321-3, 2016
                                  6. Nguyen TD et al: Visualisation of passive middle ear implants by cone beam and multi-detector computed tomography: a comparative in vitro study. Eur Radiol. 26(12):4538-44, 2016
                                  7. Azadarmaki R et al: MRI information for commonly used otologic implants: review and update. Otolaryngol Head Neck Surg. 150(4):512-9, 2014
                                  8. Malhotra M et al: Autologous total ossicular replacement prosthesis. J Laryngol Otol. 128(12):1050-5, 2014
                                  9. Whetstone J et al: Surgical and clinical confirmation of temporal bone CT findings in patients with otosclerosis with failed stapes surgery. AJNR Am J Neuroradiol. 35(6):1195-201, 2014
                                  10. Shellock FG et al: In vitro magnetic resonance imaging evaluation of ossicular implants at 3 T. Otol Neurotol. 33(5):871-7, 2012
                                  11. Zeitler DM et al: Are postoperative hearing results better with titanium ossicular reconstruction prostheses? Laryngoscope. 120(1):2-3, 2010
                                  12. Streitberger C et al: Vibrant soundbridge for hearing restoration after chronic ear surgery. Rev Laryngol Otol Rhinol (Bord). 130(2):83-8, 2009
                                  13. Burmeister HP et al: Three-dimensional imaging of active and passive middle ear prostheses using multislice computed tomography. J Comput Assist Tomogr. 32(2):304-12, 2008
                                  14. Fritsch MH et al: Phylogeny of the stapes prosthesis. Otol Neurotol. 29(3):407-15, 2008
                                  15. Rangheard AS et al: Postoperative complications in otospongiosis: usefulness of MR imaging. AJNR Am J Neuroradiol. 22(6):1171-8, 2001
                                  16. Scheid SC et al: Pneumolabyrinth: a late complication of stapes surgery. Ear Nose Throat J. 80(10):750-3, 2001
                                  17. Pickuth D et al: Vertigo after stapes surgery: the role of high resolution CT. Br J Radiol. 73(873):1021-3, 2000
                                  18. Stone JA et al: CT evaluation of prosthetic ossicular reconstruction procedures: what the otologist needs to know. Radiographics. 20(3):593-605, 2000
                                  19. Hirsch BE et al: Imaging of ossicular prostheses. Otolaryngol Head Neck Surg. 111(4):494-6, 1994
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        TERMINOLOGY

                                        • Synonyms

                                          • Ossicular replacement prosthesis (ORP)
                                        • Definitions

                                          • Ossiculoplasty: Surgical reconstruction of malfunctioned part of ossicular chain (OC) to improve or maintain conductive hearing function
                                          • Materials: Allograft > autograft > > homograft
                                            • Allograft: Synthetic ossicular replacements (titanium)
                                            • Autograft: Patient's own ossicle used
                                            • Homograft: Radiated, frozen human ossicles
                                              • Homograft use ↓ ↓ in 1990s over concern of risk for disease transmission (e.g., AIDS)
                                            • Autologous: Patient's own pinna cortical bone and cartilage
                                              • Newest entry into ORP mix
                                        • 4 Common Ossicular Replacement Prosthesis Types

                                          • Stapes prosthesis
                                          • Incus interposition graft
                                          • Partial ORP (PORP)
                                          • Total ORP (TORP)

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • CT Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Gross Pathologic & Surgical Features

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Schwartz TR et al: Gray-scale inversion on high resolution computed tomography of the temporal bone: an observational study. Ann Otol Rhinol Laryngol. 130(10):1125-31, 2021
                                                                  2. Senturk E et al: Stapedectomy in patients with dehiscent and prolapsed facial nerve. Am J Otolaryngol. 41(5):102580, 2020
                                                                  3. Gosselin E et al: Predictable prosthesis length on a high-resolution CT scan before a stapedotomy. Eur Arch Otorhinolaryngol. 275(9):2219-26, 2018
                                                                  4. Hirsch JD et al: Surgical reconstruction of the ossicular chain with custom 3D printed ossicular prosthesis. 3D Print Med. 3(1):7, 2017
                                                                  5. Fang Y et al: MPR-CT imaging for stapes prosthesis: accuracy and clinical significance. Otol Neurotol. 37(4):321-3, 2016
                                                                  6. Nguyen TD et al: Visualisation of passive middle ear implants by cone beam and multi-detector computed tomography: a comparative in vitro study. Eur Radiol. 26(12):4538-44, 2016
                                                                  7. Azadarmaki R et al: MRI information for commonly used otologic implants: review and update. Otolaryngol Head Neck Surg. 150(4):512-9, 2014
                                                                  8. Malhotra M et al: Autologous total ossicular replacement prosthesis. J Laryngol Otol. 128(12):1050-5, 2014
                                                                  9. Whetstone J et al: Surgical and clinical confirmation of temporal bone CT findings in patients with otosclerosis with failed stapes surgery. AJNR Am J Neuroradiol. 35(6):1195-201, 2014
                                                                  10. Shellock FG et al: In vitro magnetic resonance imaging evaluation of ossicular implants at 3 T. Otol Neurotol. 33(5):871-7, 2012
                                                                  11. Zeitler DM et al: Are postoperative hearing results better with titanium ossicular reconstruction prostheses? Laryngoscope. 120(1):2-3, 2010
                                                                  12. Streitberger C et al: Vibrant soundbridge for hearing restoration after chronic ear surgery. Rev Laryngol Otol Rhinol (Bord). 130(2):83-8, 2009
                                                                  13. Burmeister HP et al: Three-dimensional imaging of active and passive middle ear prostheses using multislice computed tomography. J Comput Assist Tomogr. 32(2):304-12, 2008
                                                                  14. Fritsch MH et al: Phylogeny of the stapes prosthesis. Otol Neurotol. 29(3):407-15, 2008
                                                                  15. Rangheard AS et al: Postoperative complications in otospongiosis: usefulness of MR imaging. AJNR Am J Neuroradiol. 22(6):1171-8, 2001
                                                                  16. Scheid SC et al: Pneumolabyrinth: a late complication of stapes surgery. Ear Nose Throat J. 80(10):750-3, 2001
                                                                  17. Pickuth D et al: Vertigo after stapes surgery: the role of high resolution CT. Br J Radiol. 73(873):1021-3, 2000
                                                                  18. Stone JA et al: CT evaluation of prosthetic ossicular reconstruction procedures: what the otologist needs to know. Radiographics. 20(3):593-605, 2000
                                                                  19. Hirsch BE et al: Imaging of ossicular prostheses. Otolaryngol Head Neck Surg. 111(4):494-6, 1994