Niparko J K, Kemink J L, Graham M D, Kartush J M
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor 48109.
Laryngoscope. 1988 Aug;98(8 Pt 1):822-5. doi: 10.1288/00005537-198808000-00006.
Current techniques for ossicular reconstruction include ossicular autografts and homografts, and plastic and ceramic prostheses. Experimental testing of ceramic materials has led to the development of a nonporous, bioactive form of glass ceramic (Ceravital) for tympanoplastic reconstruction. To determine the clinical usefulness of these implants, Ceravital ossicular reconstructions were evaluated in 37 patients treated at the University of Michigan Medical Center during an 18-month period. Thirty-two patients (86%) with chronic ear disease underwent Ceravital ossicular reconstruction with tympanoplasty with or without mastoidectomy. Five other patients (14%) underwent ossicular reconstruction--2 for congenital anomalies, 2 for temporal bone trauma, and 1 patient for glomus tympanicum removal. Patient follow-up ranged from 2.2 to 3.8 years, with a mean follow-up period of 2.9 years. Prosthesis extrusion occurred in one case (3%). Mean preoperative and postoperative (2-year) pure tone air-bone gaps were 41.6 dB and 21.3 dB, respectively. Hearing was improved in 35 of 37 patients (95%). Postoperative pure tone air-bone gap was closed to 20 dB or less in 23 patients (62%). Hearing gains were greater with partial rather than total reconstructions (p = 0.14) and significantly greater with intact canal wall rather than canal wall down tympanoplasties (p less than 0.05). Initial results obtained with the Ceravital ossicular prosthesis compare favorably with those obtained using other methods of alloplastic reconstruction. These preliminary data suggest that Ceravital is an effective alternative prosthetic material for ossicular reconstruction.
当前的听骨链重建技术包括听骨自体移植和同种异体移植，以及塑料和陶瓷假体。对陶瓷材料的实验测试已促成一种用于鼓室成形术重建的无孔、生物活性玻璃陶瓷（Ceravital）的开发。为了确定这些植入物的临床实用性，在18个月期间对密歇根大学医学中心治疗的37例患者的Ceravital听骨链重建情况进行了评估。32例（86%）慢性耳部疾病患者接受了Ceravital听骨链重建及鼓室成形术，伴或不伴乳突切除术。另外5例（14%）患者接受了听骨链重建——2例因先天性畸形，2例因颞骨外伤，1例因鼓室球瘤切除。患者随访时间为2.2至3.8年，平均随访期为2.9年。1例（3%）发生假体脱出。术前和术后（2年）平均纯音气骨导差分别为41.6 dB和21.3 dB。37例患者中有35例（95%）听力得到改善。23例（62%）患者术后纯音气骨导差缩小至20 dB或更小。部分重建的听力增益大于完全重建（p = 0.14），完整外耳道壁鼓室成形术的听力增益显著大于外耳道壁下鼓室成形术（p < 0.05）。使用Ceravital听骨假体获得的初步结果与使用其他同种异体重建方法获得的结果相比具有优势。这些初步数据表明，Ceravital是听骨链重建的一种有效替代假体材料。
