Long-term histological results of ossicular chain reconstruction using bioceramic implants

Abstract

Middle ear problems are addressed using tympanoplasty, which requires a mobile tympanic membrane and secure sound-conducting mechanism. The present is a long-term, retrospective, non-controlled study on the results of ossiculoplasty using bioceramic implants of autochthonous origin and which defined the statistical relevant factors that could influence the rate of implant rejection. In a cohort of 108 patients ossiculoplasties with bioceramic implants were performed and patients were followed up clinically for a period of minimum 7 years. Several factors were identified that could influence the results of the implantation and the statistical correlations were studied. The rejection rate after 9.12 years was 21% (23 patients). Histological integration rate was 79% (85 patients), similar to results reported in literature for both bioceramic and titanium implants. Hydroxyapatite has many of the ideal characteristics required to be a good prosthesis with a high degree of biocompatibility, very low extrusion rate, low risk of disease transmission and good functional results. Although perhaps considered of historical interest, bioceramic implants are cheaper and can be produced locally, which is a great advantage for struggling economies.

Keywords: ceramics; hydroxyapatite; implants; mineralization; ossiculoplasty; prostheses.

Figure 1

Preoperative absolute threshold of hearing for frequencies of 0.5-2 kHz.

Figure 2

Preoperative threshold of bone conduction for frequencies of 0.5-2 kHz.

Figure 3

The types of prosthesis used, the absolute and relative frequencies of use and the rejection rate for each type of prosthesis: Part 1.

Figure 4

The types of prosthesis used, the absolute and relative frequencies of use and the rejection rate for each type of prosthesis: Part 2.

Figure 5

Absolute frequencies of the types of prosthesis used, in relation to the state of the stapes (type on ossicular chain interruption at the vestibular end).

Figure 6

Absolute frequencies of types of prosthesis used, in relation to the state of the malleus.

Figure 7

Absolute frequencies of types of prosthesis used, in relation to the state of the incus.

Figure 8

Distribution of absolute frequencies of the postoperative moment of implant rejection.

Figure 9

Distribution of relative frequencies of the postoperative moment of implant rejection.

Figure 10

Distribution of absolute frequencies of the postoperative moment of implant rejection, as an exponentially decreasing function.

Figure 11

Influence of the type of disease (cholesteatoma) on implantation results.

Figure 12

Influence of the type of tympanic perforation on implantation results.

Figure 13

Influence of the stapes status on implantation results.

Figure 14

Influence of the incus status on implantation results.

Figure 15

Influence of the malleus' status on implantation results.

Figure 16

Influence of age groups on implantation results.

Figure 17

Influence of the rank of surgery on implantation results.

Figure 18

Influence of the type of surgery on implantation results.

Figure 19

Influence of the preoperative absolute threshold of hearing on implantation results.

Figure 20

Influence of the preoperative threshold of bone conduction on implantation results.

Figure 21

Influence of long-term results of the mastoidectomy on implantation results.

Figure 22

Influence of long-term drainage results of the mastoidectomy on implantation results.

Figure 23

Influence of epithelisation period of cavity on implantation results.

Figure 24

Influence of the presence of self-cleaning of the cavity (newly formed external ear) on implantation results.

Figure 25

Influence of the types of prosthesis on implantation results.