Ossiculoplasty using hydroxyapatite prostheses: long-term results

The surgical results of ossicular chain reconstruction using a hydroxyapatite prosthesis were evaluated in 106 ears of 101 patients who were followed up for > 5 years. Successful reconstruction was defined as: (1) postoperative air-bone gap of </= 20 db; or (2) postoperative air conduction better than 40 db; or (3) hearing gain better than 15 db. Success in hearing was obtained in 63/106 ears (59%) at 1 year; 44/65 ears (68%) in P-type (short columella) and 19/41 ears (46%) in T-type (long columella). By the fifth year, the overall success rate had deteriorated to 50%: i.e. 39/65 ears (60%) in P-type and 14/41 ears (34%) in T-type. Extrusion of the prosthesis occurred in 17 ears (16%) with a mean postoperative period of 27.7 months. The present results indicate that hydroxyapatite is a suitable material for an ossicular prosthesis, although the incidence of extrusion is high when it is placed in contact with the tympanic membrane.