The off--centered TORP.

Refinement of the techniques of ossicular reconstruction has provided satisfactory hearing results for a majority of patients with chronic ear disease. As documented in 1976, 16% of patients, those requiring a columneller type of ossiculoplasty because of absence of the malleus, did not realize the same degree of hearing improvement as with other types of reconstruction. These procedures, short and long "L-shaped" assemblies, used for patients without a malleus, resulted in a mean 27 dB bone-air gap postoperatively. The conclusion reached after comparison with the results obtained with other types of reconstruction was "... the L-shaped conductive system is less efficient than normal by the amount observed (27 dB). If these results are to be improved, a change in the method of reconstruction resulting in a more normal system may be required." Following duplication of the aforecited report a change in the method of reconstruction used for patients with the malleus absent was instituted, but perversely creating a less normal conductive system. This paper will present the one year results of those patients in which a Plastipore prosthesis has been used as a replacement of the previously described method and will compare these results with those of the past technique.