Middle Ear Surgery - Ossiculoplasty and Stapedioplasty with Titanium Prostheses

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There are 31.70 million (52.84%) persons out of 60 million deaf persons of India suffering due to various types of middle ear diseases such as:

Otosclerosis

It is defined as abnormal bone growth in the ear, eventually resulting in hearing loss. It can be an inherited disorder, resulting in abnormal hardening of bone in the middle ear and sometimes inner ear. There is 10.19 million (32.14%) out of 31.70 million suffering from otosclerosis diseases in India.

- Cholesteatoma

Cholesteatoma is a disease of the ear in which a skin cyst grows into the middle ear and mastoid. There is 6.42 million (20.24%) out of 31.70 million suffering from cholesteatoma diseases in India.

- Chronic Otitis Media

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. There is 12.45 million (39.30%) out of 31.70 million suffering from chronic otitis media diseases in India.

Rest of 2.64 million (8.32%) out of 31.70 million suffering from various other types of middle ear diseases in India.

TREATMENT OF MIDDLE EAR DISEASES

Surgical Treatment

For many years surgical treatment was instituted in middle ear diseases primarily to restore sound conduction, to control infection and to prevent serious complications. Changes in surgical techniques now have made it possible to reconstruct the diseased hearing mechanism in most cases. Various tissue grafts may be used to replace or repair the eardrum. A diseased ear bone may be replaced by middle ear prosthesis. Middle ear diseases can be treated using various types of surgical treatment/procedures such as Ossiculoplasty, Stapedioplasty, and Myringoplasty.

The goal of surgical treatment is better hearing, most typically for conversational speech. Ossiculoplasty/Stapedioplasty surgery is being performed to improve or to maintain the conductive portion of hearing loss. The aim of ossiculoplasty/stapedioplasty surgery is to reconstruct the malfunctioning ossicular chain (chain of three bones i.e. Malleus, Incus & Stapes) in the middle ear cavity. Myringoplasty surgery is performed to ventilate the middle ear, to prevent fluid from building up and to prevent infections in the middle ear cavity. All the above mentioned surgical procedures take about an hour's time and in most cases patients are discharged after 24-36 hours.

During the 1960's in the earliest stage of the development of surgical treatments, attempts were made to use biological materials such as cartilage or the remnants of the ossicular chain to create ossicular replacements. Such materials were termed auto-graft and homo-grafts materials since they were obtained from the person and donor respectively receiving the treatment.

Work in developing superior implant materials was continued until the 1970's, when bioactive materials were developed. Their name comes from their chemical structure, which promotes chemical adhesion between the tissue and the implant, effectively eliminating the need for Auto- and Homo- Grafts.

From 1970 to up till now, various types of material have been using for ossicular chain reconstruction such as Gold, Stainless Steel, Platinum, Hydroxyapatite, Teflon, Polyethylene, Glass Ionomer Cement, and Titanium.

But recently the new trend starts to perform surgery of Ossiculoplasty, Stapedioplasty, and Myringoplasty with Titanium based Middle ear implants. Titanium implants are extensively used in cardiovascular, spinal surgery, orthopedic and dental surgery as well as in reconstructive and plastic surgery.

TITANIUM - THE METAL OF CHOICE

The selection of titanium for implantation is determined by a combination of most favorable characteristics including immunity to corrosion, high bio-compatibility, strength, low modulus and density and the high capacity for joining with bone and other tissue - Osteointegration. Animal experiments in western countries have revealed that the Titanium may be implanted for an extensive length of time. Histopathological examinations have failed to reveal any cellular changes adjacent to titanium implants.

And also careful examinations of tissues adjacent to titanium have revealed neither giant cells nor macrophages, nor any other signs of inflammation. Due to these reasons, Titanium is rapidly becoming the "metal of choice" for many medical applications as well for Ossiculoplasty, Stapedioplasty, and Myringoplasty surgeries. Also Patients with Titanium medical implants may undergo for MRI-investigations without any significant adverse effects. Titanium fulfills all needs for perfect sound conduction from outer ear to inner ear and also accomplishes all requirements for myringoplasty surgery, is become more favorable material as ear surgical treatments.

Reference: Sandip Savaliya with help of Siddharth Rakholiya; Anand Marar.

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