Bioactive ceramics versus proplast implants in ossiculoplasty.

During the last decade, the surgical use of alloplasts has become more and more widespread among otologists. Yet, based upon long-term clinical surveys and histologic findings, a debate has recently arisen about the biocompatibility and structural stability of these materials. Outcomes, one to five years postoperatively, are reported here for 188 patients who underwent ossiculoplasty with either Proplast (N = 118) or Ceravital (N = 70) columellas. Ceravital performed 10% better than Proplast with regard to hearing improvement. However, almost 25% of the Ceravital patients did not attain an appreciable auditory gain;even compared with Proplast's 35% figure, this is still too high a figure. The bioactive ceramic yielded an extrusion rate of 8%, whereas 18% of the Proplast prostheses with cartilage interposition were rejected. Causes of failure other than extrusion were detected in a non-negligible number of cases. Actually, columellar ossiculoplasty requires the most realistic expectations and the wisest surgical strategy. Besides the biophysical behavior of the implant, control of the primary disease and the achievement of the best prereconstructive anatomic set-up are critical prerequisites to a fully satisfactory outcome. In this context, staging of the procedure for functional aims seems to play a major role that has perhaps been neglected too often.