Tympanoplastik – Neues und neu Beleuchtetes

 

 Buy Article Permissions and Reprints

Zusammenfassung

Seit Beginn der rekonstruktiven Mittelohrchirurgie wurden Techniken und Biomaterialien zum Wiederaufbau des zerstörten Schallleitungsapparates beständig weiterentwickelt. Gleichzeitig wurden von Beginn an die Operationsergebnisse ausgewertet, um Erfolg oder Misserfolg der Therapien zu identifizieren. In den letzten Jahren nehmen Qualitätsbewertung und -sicherung im medizinischen Alltag einen wachsenden Stellenwert ein, der auch Einzug in die Mittelohrchirurgie hält. Bei der differenzierten und umfassenden Qualitätsbewertung kommt der exakten Definition und Erfassung der Zielparameter eine entscheidende Rolle zu. Diese umfasst heute nicht nur audiologische Daten, die prä- und postoperativ miteinander verglichen werden, sondern auch Bewertungen der individuellen Faktoren, die einen Einfluss auf das postoperative Gesamtergebnis nach einer Tympanoplastik haben, wie bspw. die gesundheitsspezifische Lebensqualität. Die Patientenselektion und Beschreibung der klinischen Ausgangssituation, der intraoperativ identifizierte Schaden am Schallleitungsapparat und die Rekonstruktionstechnik, die Wahl des Frequenzbereiches in der Audiometrie und das Nachbeobachtungsintervall sind nur einige der Faktoren, die die Ergebnisaussage beeinflussen. Werden sie nicht dokumentiert oder das Patientenkollektiv danach stratifiziert, sind die Aussagen einer Studie oder im Vergleich verschiedener Arbeiten nur bedingt aussagekräftig. Das vorliegende Referat soll daher eine Übersicht und Bewertung der Einflussfaktoren und der Bewertungsinstrumente liefern, um valide Aussagen aus klinischen Studien ziehen zu können. Weitere Bewertungsinstrumente für die intra- und postoperative Qualitätskontrolle stehen heute bereits in Studien zur Verfügung und liefern Aussagen über die intraoperative Rekonstruktionsqualität bzw. postoperativ über mögliche Ursachen nicht optimaler Hörergebnisse mittels Bildgebung. Im Bereich der Implantatentwicklung wurden in den letzten Jahren zunehmend funktionelle Elemente in die Mittelohrprothesen integriert, die nicht nur den Anforderungen der Schallübertragung genügen, sondern zudem atmosphärische Luftdruckschwankungen kompensieren können. Gerade in Kombination mit weiteren Implantat-Bausteinen und der Umsetzung eines modularen Prothesenkonzepts können experimentell wie klinisch vielversprechende Ergebnisse in Aussicht gestellt werden.

Abstract

Techniques and biomaterials for reconstructive middle ear surgery are under steady, ongoing development. At the same time, clinical post-surgery results are evaluated to determine success or failure of the therapy. Routine quality assessment and assurance is of growing importance in the medical field, and therefore also in middle ear surgery. The exact definition and acquisition of outcome parameters is essential for both a comprehensive and detailed quality assurance. These parameters are not the audiological results alone, but also additional individual parameters which influence the postoperative outcome after tympanoplasty. Selection of patients and the preoperative clinical situation, the extent of the ossicular chain destruction, the chosen reconstruction technique and material, the audiometric frequency selection and the observational interval are only some of them. If these parameters are not well documented comparative analyses between different studies are of limited value. The present overview aims to describe, compare and evaluate some of the existing assessment and scoring systems for middle ear surgery. Additionally, new methods for an intraoperative quality assessment in ossiculoplasty and the postoperative evaluation of suboptimal hearing results with imaging techniques are available. In the area of implant development functional elements were integrated in prostheses to enable not only good sound transmission but also compensation of occurring atmospheric pressure changes. In combination with other components for ossicular repair they can be used in a modular manner which, so far show experimentally and clinically promising results.

• Literatur

• 1 Wullstein H. Theory and Practice of Tympanoplasty. Laryngoscope 1956; 66: 1076-1093
  PubMedGoogle Scholar
• 2 Zöllner F. Surgical technics for the improvement of sound conduction after radical operation. Arch Ital Otol Rinol Laringol 1953; 64: 455-468
  PubMedGoogle Scholar
• 3 Hüttenbrink K-B. Die Funktion der Gehörknöchelchenkette und der Muskeln des Mittelohres. Laryngo-Rhino-Otol 1995
  PubMed
• 4 Hüttenbrink K-B. Zur Rekonstruktion des Schallleitungsapparates unter biomechanischen Gesichtspunkten. Laryngo-Rhino-Otol 2000; 79: 23-51
  PubMedGoogle Scholar
• 5 Zahnert T. Laser in der Ohrforschung. Laryngo-Rhino-Otol 2003; 82 (Suppl. 01) 157-180
  PubMedGoogle Scholar
• 6 Zahnert T. Hearing disorder. Surgical management. Laryngo-Rhino-Otol 2005; 84 (Suppl. 01) S37-S50
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Beutner D, Hüttenbrink KB. Passive and active middle ear implants. Laryngorhinootologie 2009; 88 (Suppl. 01) S32-S47
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Geyer G. Implants in middle ear surgery. Eur Arch Otorhinolaryngol Suppl 1992; 1: 185-221
  PubMedGoogle Scholar
• 9 Dost P. Biomaterials in reconstructive middle ear surgery. Laryngo-Rhino-Otol 2000; 79: 53-72
  Article in Thieme ConnectPubMedGoogle Scholar
• 10 Hildmann H. Grundzüge einer differenzierten Cholesteatom-Chirurgie. Laryngo-Rhino-Otol 2000; 79: 73-94
  PubMedGoogle Scholar
• 11 Schwager K. Reconstruction of the middle ear in abnormalities. Laryngorhinootologie 2007; 86 (Suppl. 01) S141-S155
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Bhattacharyya N. Outcomes research in otology. ORL J Otorhinolaryngol Relat Spec 2004; 66: 214-220
  CrossrefPubMedGoogle Scholar
• 13 Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg 1995; 113: 186-187
  CrossrefPubMedGoogle Scholar
• 14 Linstrom C, Silverman C, Rosen A, Meiteles L. Bone Conduction Impairment in Chronic Ear Disease. Ann Otol Rhinol Laryngol 2001; 110: 437-441
  CrossrefPubMedGoogle Scholar
• 15 Tuz M, Doğru H, Uygur K, Gedikli O. Improvement in Bone Conduction Threshold after Tympanoplasty. Otolaryngol Head Neck Surg 2000; 123: 775-778
  CrossrefPubMedGoogle Scholar
• 16 Vartiainen E, Seppa J. Results of bone conduction following surgery for chronic ear disease. Eur Arch Otorhinolaryngol 1997; 254: 384-386
  CrossrefPubMedGoogle Scholar
• 17 Black B. Reporting results in ossiculoplasty. Otol Neurotol 2003; 24: 534-542
  CrossrefPubMedGoogle Scholar
• 18 Gurgel RK, Jackler RK, Dobie RA, Popelka GR. A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 2012; 147: 803-807
  CrossrefPubMedGoogle Scholar
• 19 Unpublizierte Daten. Qualitätsparameter und -merkmale in klinischen Studien zur Hörverbesserung. Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Dresden 2016;
  PubMed
• 20 Dawes PJD, Welch D, Lee P. How we do it: tympanoplasty: are different three- and four-frequency averages comparable?. Clin Otolaryngol 2006; 31: 321-324
  CrossrefPubMedGoogle Scholar
• 21 Lailach S. Cholesteatomrezidivhäufigkeit und postoperatives Hörvermögen in Abhängigkeit von der gewählten Operationsmethode. TU Dresden, Medizinische Fakultät, HNO-Klinik, 2013
  PubMed
• 22 Epstein RS, Sherwood LM. From outcomes research to disease management: a guide for the perplexed. Ann Intern Med 1996; 124: 832-837
  CrossrefPubMedGoogle Scholar
• 23 Black N. Patient reported outcome measures could help transform healthcare. BMJ 2013; 346: f167-f167
  CrossrefPubMedGoogle Scholar
• 24 Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993; 118: 622-629
  CrossrefPubMedGoogle Scholar
• 25 Baumann I, Kurpiers B, Plinkert PK, Praetorius M. Development and validation of the Chronic Otitis Media Outcome Test 15 (COMOT-15). Measurement of health-related quality of life in patients with chronic otitis media. HNO 2009; 57: 889-895
  CrossrefPubMedGoogle Scholar
• 26 Lailach S, Kemper M, Lasurashvili N, Beleites T, Zahnert T, Neudert M. Health-related quality of life measurement after cholesteatoma surgery: comparison of three different surgical techniques. Eur Arch Otorhinolaryngol 2015; 272: 3177-3185
  CrossrefPubMedGoogle Scholar
• 27 Bächinger D, Röösli C, Ditzen B, Huber AM. Development and validation of the Zurich chronic middle ear inventory (ZCMEI-21): an electronic questionnaire for assessing quality of life in patients with chronic otitis media. Eur Arch Otorhinolaryngol 2016
  PubMed
• 28 Schuhmacher J. Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Göttingen, Bern: Hogrefe; 2003
  Google Scholar
• 29 Nadol JJB, Staecker H, Gliklich RE. Outcomes assessment for chronic otitis media: the Chronic Ear Survey. Laryngoscope 2000; 110: 32-35
  CrossrefPubMedGoogle Scholar
• 30 Phillips JS, Yung MW. COMQ-12 scores in adult patients without chronic middle ear disease. Clin Otolaryngol 2014; 39: 362-367
  CrossrefPubMedGoogle Scholar
• 31 Oorts E, Phillips J, Van de Heyning P, Yung M, Van Rompaey V. Dutch Health-Related Quality of Life Measure for Chronic Otitis Media. B-ENT 2015; 11: 291-295
  PubMedGoogle Scholar
• 32 Hallberg LRM, Hallberg U, Kramer SE. Self-reported hearing difficulties, communication strategies and psychological general well-being (quality of life) in patients with acquired hearing impairment. Disabil Rehabil 2008; 30: 203-212
  CrossrefPubMedGoogle Scholar
• 33 Bakir S, Kinis V, Bez Y, Gun R, Yorgancilar E, Ozbay M, Aguloglu B, Meric F. Mental health and quality of life in patients with chronic otitis media. Eur Arch Otorhinolaryngol 2013; 270: 521-526
  CrossrefPubMedGoogle Scholar
• 34 Choi SY, Cho Y-S, Lee NJ, Lee J, Chung W-H, Hong SH. Factors associated with quality of life after ear surgery in patients with chronic otitis media. Arch Otolaryngol Head Neck Surg 2012; 138: 840-845
  CrossrefPubMedGoogle Scholar
• 35 Vos CD, Gersdorff M, Gérard J-M. Prognostic factors in ossiculoplasty. Otol Neurotol 2007; 28: 61-67
  CrossrefPubMedGoogle Scholar
• 36 Bellucci R. Basic considerations for success in tympanoplasty. Arch Otolaryngol 1969; 90: 732-741
  CrossrefPubMedGoogle Scholar
• 37 Bellucci RJ. Dual classification of tympanoplasty. Laryngoscope 1973; 83: 1754-1758
  PubMedGoogle Scholar
• 38 Black B. Ossiculoplasty prognosis: the spite method of assessment. Am J Otol 1992; 13: 544-551
  PubMedGoogle Scholar
• 39 Austin D. Types and indications of staging. Arch Otolaryngol 1969; 89: 235-242
  CrossrefPubMedGoogle Scholar
• 40 Kartush JM. Ossicular chain reconstruction. Capitulum to Malleus. Otolaryngologic Clinics of North America. 1994; 27: 689-715
  PubMedGoogle Scholar
• 41 Becvarovski Z, Kartush JM. Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI). Laryngoscope 2001; 111: 1806-1811
  CrossrefPubMedGoogle Scholar
• 42 Dornhoffer JL, Gardner E. Prognostic factors in ossiculoplasty: a statistical staging system. Otol Neurotol 2001; 22: 299-304
  CrossrefPubMedGoogle Scholar
• 43 Nishihara S, Goode R. Experimental study of the acoustic properties of incus replacement prostheses in a human temporal bone model. Am J Otol 1994; 15: 485-494
  PubMedGoogle Scholar
• 44 Vlaming MS, Feenstra L. Studies on the mechanics of the reconstructed human middle ear. Clin Otolaryngol 1986; 11: 411-422
  CrossrefPubMedGoogle Scholar
• 45 Koike T, Wada H, Kobayashi T, Takasaka T. Finite-element method analysis of a reconstructed middle ear 1997
  PubMed
• 46 Koike T, Wada H, Kobayashi T. Modeling of the human middle ear using the finite-element method. J Acoust Soc Am 2002; 111: 1306-1317
  CrossrefPubMedGoogle Scholar
• 47 Austin DF. Ossicular reconstruction. Arch Otolaryngol 1971; 94: 525-535
  CrossrefPubMedGoogle Scholar
• 48 Redaelli de Zinis LO. Titanium vs. hydroxyapatite ossiculoplasty in canal wall down mastoidectomy. Arch Otolaryngol Head Neck Surg 2008; 134: 1283-1287
  CrossrefPubMedGoogle Scholar
• 49 Umit T, Ozgur Y, Bilgehan G, Volkan SA, Sezim SA. Results of primary ossiculoplasty and prognostic factors in canal wall-down tympanoplasty. J Craniofac Surg 2010; 21: 407-410
  CrossrefPubMedGoogle Scholar
• 50 Bared A, Angeli SI. Malleus Handle: Determinant of Success in Ossiculoplasty. Am J Otolaryngol 2010; 31: 235-240
  CrossrefPubMedGoogle Scholar
• 51 Meulemans J, Wuyts FL, Forton GEJ. Middle Ear Reconstruction Using the Titanium Kurz Variac Partial Ossicular Replacement Prosthesis: Functional Results. JAMA Otolaryngol Head Neck Surg 2013; 139: 1017-1025
  CrossrefPubMedGoogle Scholar
• 52 Blom EF, Gunning MN, Kleinrensink NJ, Lokin ASHJ, Bruijnzeel H, Smit AL, Grolman W. Influence of ossicular chain damage on hearing after chronic otitis media and cholesteatoma surgery: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 2015; 141: 974-982
  CrossrefPubMedGoogle Scholar
• 53 Gurr A, Hildmann H, Stark T, Dazert S. Treatment of tympanosclerosis. HNO 2008; 56: 651-657 quiz 658
  CrossrefPubMedGoogle Scholar
• 54 Nadol JB. Surgery of the ear and temporal bone. New York: Raven; 1993
  Google Scholar
• 55 Schuhknecht. Pathology of the ear. 2nd edn. Philadelphia: N.p.: Lea und Febiger; 1993
  Google Scholar
• 56 Albu S, Babighian G, Trabalzini F. Prognostic factors in tympanoplasty. The American Journal of Otology 1998; 19: 136-140
  PubMedGoogle Scholar
• 57 Felek SA, Celik H, Islam A, Elhan AH, Demirci M, Samim E. Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index. Am J Otolaryngol 2010; 31: 325-331
  CrossrefPubMedGoogle Scholar
• 58 Iniguez-Cuadra R, Alobid I, Borés-Domenech A, Menéndez-Colino L-M, Caballero-Borrego M, Bernal-Sprekelsen M. Type III tympanoplasty with titanium total ossicular replacement prosthesis: anatomic and functional results. Otol Neurotol 2010; 31: 409-414
  CrossrefPubMedGoogle Scholar
• 59 Edfeldt L, Strömbäck K, Kinnefors A, Rask-Andersen H. Surgical treatment of adult cholesteatoma: long-term follow-up using total reconstruction procedure without staging. Acta Otolaryngol 2013; 133: 28-34
  PubMedGoogle Scholar
• 60 Lesinskas E, Stankeviciute V. Results of revision tympanoplasty for chronic non-cholesteatomatous otitis media. Auris Nasus Larynx 2011; 38: 196-202
  CrossrefPubMedGoogle Scholar
• 61 Minovi A, Venjacob J, Volkenstein S, Dornhoffer J, Dazert S. Functional results after cholesteatoma surgery in an adult population using the retrograde mastoidectomy technique. Eur Arch Otorhinolaryngol 2014; 271: 495-501
  CrossrefPubMedGoogle Scholar
• 62 Martin TPC, Weller M, Kim D, Smith MCF. Results of primary ossiculoplasty in ears with an intact stapes superstructure and malleus handle: inflammation in the middle ear at the time of surgery does not affect hearing outcomes. Clin Otolaryngol 2009; 34: 218-224
  CrossrefPubMedGoogle Scholar
• 63 Stankovic MD. Audiologic results of surgery for cholesteatoma: short- and long-term follow-up of influential factors. Otol Neurotol 2008; 29: 933-940
  CrossrefPubMedGoogle Scholar
• 64 Goldenberg R. Hydroxylapatite ossicular replacement prostheses: preliminary results. Laryngoscope 1990; 100: 693-700
  PubMedGoogle Scholar
• 65 Mills RP. The influence of pathological and technical variables on hearing results in ossiculoplasty. Clin Otolaryngol Allied Sci 1993; 18: 202-205
  PubMedGoogle Scholar
• 66 Huber AM, Ma F, Felix H, Linder T. Stapes prosthesis attachment: the effect of crimping on sound transfer in otosclerosis surgery. Laryngoscope 2003; 113: 853-858
  CrossrefPubMedGoogle Scholar
• 67 Hsu GS. Improving hearing in stapedectomy with intraoperative auditory brainstem response. Otolaryngol Head Neck Surg 2011; 144: 60-63
  CrossrefPubMedGoogle Scholar
• 68 Morawski K, Niemczyk K, Sokolowski J, Hryciuk A, Bartoszewicz R. Intraoperative monitoring of hearing improvement during ossiculoplasty by Laser-Doppler vibrometry, auditory brainstem responses, and electrocochleography. Otolaryngol Head Neck Surg 2014; 736-742
  PubMedGoogle Scholar
• 69 Verhaegen VJO, Mulder JJS, Noten JFP, Luijten BMA, Cremers CWRJ, Snik AFM. Intraoperative auditory steady state response measurements during vibrant soundbridge middle ear implantation in patients with mixed hearing loss: preliminary results. Otol Neurotol 2010; 31: 1365-1368
  PubMedGoogle Scholar
• 70 Radeloff A, Shehata-Dieler W, Rak K, Scherzed A, Tolsdorff B, Hagen R, Mueller J, Mlynski R. Intraoperative monitoring of active middle ear implant function in patients with normal and pathologic middle ears. Otol Neurotol 2011; 32: 104-107
  CrossrefPubMedGoogle Scholar
• 71 Zahnert T, Mocanu H, Lasurashvili N, Bornitz M. Intraoperative monitoring of optimal positioning of middle ear prothesis: a feasibility study in human temporal Bones 2012
  PubMed
• 72 Rutschmann J. Magnetic audition – auditory stimulation by means of alternating magnetic fields acting on a permanent magnet fixed to the eardrum. IRE Trans Med Electron 1959; ME-6: 22-23
  PubMedGoogle Scholar
• 73 Wilska A. A direct method for determining threshold amplitudes of the eardrum at various frequencies. The middle ear 1959; 76-79
  PubMedGoogle Scholar
• 74 Goode R. An implantable hearing aid. State of the art. Transactions-American Academy of Ophthalmology and Otolaryngology. American Academy of Ophthalmology and Otolaryngology 1970; 74: 128
  PubMedGoogle Scholar
• 75 Perkins R. Earlens tympanic contact transducer: a new method of sound transduction to the human ear. Otolaryngol Head Neck Surg 1996; 114: 720-728
  CrossrefPubMedGoogle Scholar
• 76 Perkins R, Fay JP, Rucker P, Rosen M, Olson L, Puria S. the earlens system: new sound transduction methods. Hear Res 2010; 263: 104-113
  CrossrefPubMedGoogle Scholar
• 77 Peacock J, Dirckx J, von Unge M. Towards quantitative diagnosis of ossicular fixation: measurement of stapes fixations using magnetically driven ossicles in human temporal bones. Acta Otolaryngol 2015; 135: 880-885
  CrossrefPubMedGoogle Scholar
• 78 Peacock J, Dirckx J, von Unge M. Intraoperative assessment of ossicular fixation. Hearing Research 2016; DOI: 10.1016/j.heares.2016.03.004.
  CrossrefPubMedGoogle Scholar
• 79 Peacock J, Pintelon R, Dirckx J. Nonlinear vibration response measured at umbo and stapes in the rabbit middle ear. J Assoc Res Otolaryngol 2015; DOI: 10.1007/s10162-015-0535-7.
  CrossrefPubMedGoogle Scholar
• 80 Zahnert T, Metasch M-L, Seidler H, Bornitz M, Lasurashvili N, Neudert M. A new intraoperative real-time monitoring system for reconstructive middle ear surgery: an experimental and clinical feasibility study. Otol Neurotol [accepted 2016/08/16] [im Druck] 2016
  PubMed
• 81 ASTM. Standard practice for describing system output of implantable middle ear hearing devices 2005; F2504_05
  PubMed
• 82 Asai M, Huber A, Goode RL. Analysis of the best site on the stapes footplate for ossicular chain reconstruction. Acta Otolaryngol. 1999; 119: 356-361
  CrossrefPubMedGoogle Scholar
• 83 Zahnert T, Hüttenbrink K-B. Pitfalls in ossicular chain reconstruction. HNO 2005; 53: 89-102 quiz 103
  CrossrefPubMedGoogle Scholar
• 84 Hirsch BE, Weissman JL, Curtin HD, Kamerer DB. Imaging of ossicular prostheses. Otolaryngol Head Neck Surg 1994; 111: 494-496
  CrossrefPubMedGoogle Scholar
• 85 Mukherji SK, Mancuso AA, Kotzur IM, Slattery 3rd WH, Swartz JD, Tart RP, Nall A. CT of the temporal bone: findings after mastoidectomy, ossicular reconstruction, and cochlear implantation. AJR Am J Roentgenol 1994; 163: 1467-1471
  CrossrefPubMedGoogle Scholar
• 86 Watanabé N, Bondo J, Mogi G. Three-dimensional investigation of the postoperative condition after ossiculoplasty with hydroxylapatite corp. (Running title; 3-D investigation of Corp). Rev Laryngol Otol Rhinol (Bord) 1995; 116: 23-26
  PubMedGoogle Scholar
• 87 Stone JA, Mukherji SK, Jewett BS, Carrasco VN, Castillo M. CT evaluation of prosthetic ossicular reconstruction procedures: what the otologist needs to know. Radiographics 2000; 20: 593-605
  CrossrefPubMedGoogle Scholar
• 88 Kobayashi T, Gyo K, Shinohara T, Yanagihara N. Ossicular reconstruction using hydroxyapatite prostheses with interposed cartilage. Am J Otolaryngol 2002; 23: 222-227
  CrossrefPubMedGoogle Scholar
• 89 Schwager K. Epithelisierung von Titanprothesen im Mittelohr des Kaninchens. Modellvorstellungen zur Mukosaentwicklung. Laryngo-Rhino-Otol 1998; 77: 38-42
  PubMedGoogle Scholar
• 90 Vassbotn FS, Møller P, Silvola J. Short-term results using Kurz titanium ossicular implants. Eur Arch Otorhinolaryngol 2007; 264: 21-25
  CrossrefPubMedGoogle Scholar
• 91 Fisch U, May J, Linder T, Naumann IC. A new L-shaped titanium prosthesis for total reconstruction of the ossicular chain. Otol Neurotol 2004; 25: 891-902
  CrossrefPubMedGoogle Scholar
• 92 Offergeld C, Kromeier J, Merchant SN, Lasurashvili N, Neudert M, Bornitz M, Laszig R, Zahnert T. Experimental investigation of rotational tomography in reconstructed middle ears with clinical implications. Hear Res 2010; 263: 191-197
  CrossrefPubMedGoogle Scholar
• 93 Offergeld C, Kromeier J, Aschendorff A, Maier W, Klenzner T, Beleites T, Zahnert T, Schipper J, Laszig R. Rotational tomography of the normal and reconstructed middle ear in temporal bones: an experimental study. Eur Arch Otorhinolaryngol 2007; 264: 345-351
  CrossrefPubMedGoogle Scholar
• 94 Offergeld C. Klinische und experimentelle Untersuchungen zur Qualitätssicherung nach rekonstruktiver Mittelohrchirurgie. Universitäts-Hals-Nasen-Ohren-Klinik der Albert-Ludwigs-Universität Freiburg 2008
  PubMed
• 95 Zaoui K, Kromeier J, Neudert M, Beleites T, Zahnert T, Laszig R, Offergeld C. Clinical investigation of flat panel ct following middle ear reconstruction: a study of 107 patients. Eur Radiol 2014; 24: 587-594
  CrossrefPubMedGoogle Scholar
• 96 Beleites T, Bornitz M, Zahnert T. Übertragungseigenschaften alternativ designter Gehörknöchelchenprothesen. Biomaterialien 2005; 6: 12-13
  PubMedGoogle Scholar
• 97 Fisch U, May J. Tympanoplasty, mastoidectomy and stapes surgery. Stuttgart, New York: Georg Thieme; 1994
  Google Scholar
• 98 Wehrs R. The homograft tympanic membrane after 12 years. Ann Otol Rhinol Laryngol 1982; 91: 533-537
  CrossrefPubMedGoogle Scholar
• 99 Black B. Neomalleus ossiculoplasty. Otol Neurotol 2002; 23: 636-642
  CrossrefPubMedGoogle Scholar
• 100 Vincent R, Bittermann AJN, Wenzel G, Oates J, Sperling N, Lenarz T, Grolman W. Ossiculoplasty in missing malleus and stapes patients: experimental and preliminary clinical results with a new malleus replacement prosthesis with the otology-neurotology database. Otol Neurotol 2013; 34: 83-90
  CrossrefPubMedGoogle Scholar
• 101 Hamzavi S, Riss D, Gstoettner W. Malleus replacement prosthesis stapedectomy in a patient with otosclerosis. Laryngoscope 2013; 123: 3194-3196
  CrossrefPubMedGoogle Scholar
• 102 Lüers JC, Huttenbrink K-B, Mickenhagen A, Beutner D. A modified prosthesis head for middle ear titanium implants – experimental and first clinical results. Otol Neurotol 2010; 31: 624-629
  PubMedGoogle Scholar
• 103 Beutner D, Luers JC, Bornitz M, Zahnert T, Huttenbrink K-B. Titanium clip ball joint: a partial ossicular reconstruction prosthesis. Otol Neurotol 2011; 32: 646-649
  CrossrefPubMedGoogle Scholar
• 104 Gostian AO, Pazen D, Luers JC, Huttenbrink KB, Beutner D. Titanium ball joint total ossicular replacement prosthesis – experimental evaluation and midterm clinical results. Hear Res 2013; 301: 100-104
  CrossrefPubMedGoogle Scholar
• 105 Birk S, Brase C, Hornung J. Experience with the use of a partial ossicular replacement prosthesis with a ball-and-socket joint between the plate and the shaft. Otol Neurotol 2014; 35: 1248-1250
  PubMedGoogle Scholar
• 106 Hüttenbrink K-B, Zahnert T, Beutner D, Hofmann G. The cartilage guide: a solution for anchoring a columella-prosthesis on footplate. Laryngo-Rhino-Otol 2004; 83: 450-456
  PubMedGoogle Scholar
• 107 Schmid G, Steinhardt U, Heckmann W. The omega connector – a module for jointed coupling of titanium total prostheses in the middle ear. Laryngorhinootologie 2009; 88: 782-788
  Article in Thieme ConnectPubMedGoogle Scholar
• 108 Beleites T, Bornitz M, Offergeld C, Neudert M, Hüttenbrink K-B, Zahnert T. Experimental investigations on middle ear prostheses with an integrated micro joint. Laryngo-Rhino-Otol 2007; 86: 649-654
  PubMedGoogle Scholar
• 109 Johnstone BM, Taylor KJ. Physiology of the middle ear transmission system. J Otolaryngol Soc Australia 1971; 3: 226-228
  PubMedGoogle Scholar
• 110 Arechvo I, Zahnert T, Bornitz M, Neudert M, Lasurashvili N, Simkunaite-Rizgeliene R, Beleites T. The ostrich middle ear for developing an ideal ossicular replacement prosthesis. Eur Arch Otorhinolaryngol January 2012; 270: 37-44
  PubMedGoogle Scholar
• 111 Arechvo I, Bornitz M, Lasurashvili N, Zahnert T, Beleites T. New total ossicular replacement prostheses with a resilient joint: experimental data from human temporal bones. Otol Neurotol 2012; 33: 60-66
  CrossrefPubMedGoogle Scholar
• 112 Pau HW, Hüttenbrink KB. Experimentelle Untersuchungen zur statischen Belastung der Fußplatte bei Rekonstruktion des Schalleitungsapparates. Laryng Rhinol Otol 1988; 67: 331-334
  Article in Thieme ConnectPubMedGoogle Scholar
• 113 Jahnke K. Fortschritte in der Mikrochirurgie des Mittelohres. HNO 1987; 35: 1-13
  PubMedGoogle Scholar
• 114 Dost P, Ellermann S, Missfeldt NN, Jahnke K. Reconstruction of the superstructure of the stapes in guinea pigs with biovitro ceramic and silicone foil. HNO 2002; 50: 1053-1056
  CrossrefPubMedGoogle Scholar
• 115 Neudert M, Berner M, Bornitz M, Beleites T, Ney M, Zahnert T. Osseointegration of prostheses on the stapes footplate: evaluation of the biomechanical feasibility by using a finite element model. J Assoc Res Otolaryngol 2007; 8: 411-421
  CrossrefPubMedGoogle Scholar
• 116 Neudert M, Beleites T, Ney M, Kluge A, Lasurashvili N, Bornitz M, Scharnweber D, Zahnert T. Osseointegration of titanium prostheses on the stapes footplate. J Assoc Res Otolaryngol 2010; 11: 161-171
  CrossrefPubMedGoogle Scholar
• 117 Elbrond O, Elpem BS. Reconstruction of ossicular chain in incus defects. Arch Otolaryng 1965; 82: 603-608
  CrossrefPubMedGoogle Scholar
• 118 Morris DP, Bance M, Wijhe RG, van Kiefte M, Smith R. Optimum tension for partial ossicular replacement prosthesis reconstruction in the human middle ear. Laryngoscope 2004; 114: 305-308
  CrossrefPubMedGoogle Scholar
• 119 Gan RZ, Yang F, Zhang X, Nakmali D. Mechanical properties of stapedial annular ligament. Medical engineering & physics 2011; 33: 330-339
  CrossrefPubMedGoogle Scholar
• 120 Lauxmann M, Eiber A, Haag F, Ihrle S. Nonlinear Stiffness Characteristics Of The Annular Ligament. J Acoust Soc Am 2014; 136: 1756
  CrossrefPubMedGoogle Scholar
• 121 Neudert M, Bornitz M, Lasurashvili N, Schmidt U, Beleites T, Zahnert T. Impact of prosthesis length on tympanic membrane’s and annular ligament’s stiffness and the resulting middle ear sound transmission. Otol Neurotol [accepted 2016/02/04] 2016
  PubMed
• 122 Vincent R, Sperling NM, Oates J, Osborne J. Ossiculoplasty with intact stapes and absent malleus: the silastic banding technique. Otol Neurotol 2005; 26: 846-852
  CrossrefPubMedGoogle Scholar
• 123 Austin D. Reporting results in tympanoplasty. Am J Otol 1985; 6: 85-88
  PubMedGoogle Scholar