Practical Use of Total and Partial Ossicular Replacement Prostheses in Ossiculoplasty

The use of porous polyethylene total and partial ossicular replacement prostheses (TOPs and POPs) for ossicular reconstruction in middle ear surgery was retrospectively reviewed at the Warren Otologic Group, a tertiary referral center for otologic problems. Extrusion rates, lower than those previously reported, and improvement in hearing results were found in 250 cases. Follow-up ranged from 6 months to 8 years. This paper details the optimal placement and relationships of the prosthesis, the interposed tragal cartilage, and the drum. Modifications to the prosthesis have increased stability and ease of reconstruction. The hearing results of both TOP and POP reconstruction, and comparison with the literature, will be presented. With TOPs, the air-bone gap was closed to within 20 dB in 67% of cases. With POPs, similar results were obtained in 81% of cases.