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Is there a “best” stapes prosthesis?
Author(s) -
Ruckenstein Michael J.,
Nicolli Elizabeth A.
Publication year - 2012
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.23353
Subject(s) - incus , stapedectomy , prosthesis , stapes , piston (optics) , otosclerosis , materials science , medicine , surgery , middle ear , wavefront , physics , optics
BACKGROUND The surgical approach to otosclerosis has evolved significantly over the decades following Shea’s first stapedectomy in 1956. The procedure has progressed from total removal of the stapes footplate, to partial stapedectomy, and now to small fenestra stapedotomy using a microdrill or laser. Likewise, the choice of stapes prosthesis has changed over the years in terms of size, shape, and composition. The three most common prosthesis designs are the wire loop, piston, and bucket handle, although there are many variations on each. Piston diameter has ranged from 0.3 to 0.8 mm. Prostheses have been made from a wide array of materials including Teflon, stainless steel, platinum, gold, and more recently a nickel titanium alloy, nitinol. Recent investigations have focused on the manner in which the prosthesis fixates on the incus. Traditionally, the most common prosthesis used is a piston with a wire loop on the end. This loop is secured to the incus by using a forceps to crimp the wire down around the incus. The crimping of the wire loop is arguably the most critical step in stapes surgery. If done too loosely, the prosthesis may shift and lead to a deterioration in hearing. If crimped too tightly, reduced perfusion may lead to incus erosion and necrosis.