Comparison of the mechanical performance of ossiculoplasty using a prosthetic malleus-to-stapes head with a tympanic membrane-to-stapes head assembly in a human cadaveric middle ear model

Hypothesis: Ossiculoplasty using prosthetic reconstruction with a malleus assembly to the stapes head will result in better transmission of vibrations from the eardrum to the stapes foot-plate than reconstruction with a tympanic membrane assembly to the stapes head. Both types of reconstruction will be affected by tension of the prosthesis. Background: Theories (and some clinical studies) that the shape of the normal tympanic membrane is important suggest that prosthetic reconstruction to the malleus performs better than reconstruction to the tympanic membrane. This has not been previously tested by directly measuring vibration responses in the human ear. Our previous work suggests that tympanic membrane assembly to the stapes head type prostheses performed best under low tension. This had not been previously tested for malleus assembly to the stapes head type prostheses. Methods: Hydroxyapatite prostheses were used to reconstruct a missing incus defect in a fresh cadaveric human ear model. Two types of prostheses were used, one from the stapes head to the malleus (malleus assembly to the stapes head), the other from the stapes head to the tympanic membrane (tympanic membrane assembly to the stapes head). Stapes footplate center responses were measured using a laser Doppler vibrometer in response to calibrated acoustic frequency sweeps. Results: Tension had a very significant effect on both types of prostheses in the lower frequencies. Loose tension was best overall. The malleus assembly to the stapes head type prostheses consistently performed better than the tympanic membrane assembly to the stapes head type prostheses when stratified for tension. Conclusion: Tension has a significant effect on prosthesis function. Malleus assembly to the stapes head type prostheses generally result in better transmission of vibrations to the stapes footplate than tympanic membrane assembly to the stapes head type prostheses.