Titanium vs hydroxyapatite ossiculoplasty in canal wall down mastoidectomy

OBJECTIVE: To report hearing results using a titanium ossicular replacement prosthesis during canal wall down mastoidectomy with tympanoplasty to treat cholesteatoma. DESIGN: Retrospective medical record review. SETTING: Referral university hospital. PATIENTS: Patients with cholesteatoma treated with primary or revision canal wall down mastoidectomy with tympanoplasty in a single stage. Patients with implanted hydroxyapatite prostheses composed a matched control group. MAIN OUTCOME MEASURES: Medical records were reviewed for type of ossicular condition, type of prosthesis, and hearing threshold at 1-year follow-up. RESULTS: Results are reported as the 5-frequency average air conduction gain, bone conduction gain, and air-bone gap. The malleus handle was present in 24 patients, and the stapes superstructure in 22 patients. Mean (SD) air conduction gain was 7.6 (14.7) dB (P = .001); it was 8.7 (12.0) dB in the group with titanium prostheses and 6.3 (17.4) dB in the group with hydroxyapatite prostheses (P = .54). Bone conduction gain was 1.1 (4.9) dB (P = .19). No patients experienced postoperative impairment of bone threshold greater than 5 dB. Postoperative air-bone gap was 26.5 (15.3) dB; it was 23.8 (15.7) dB in the titanium group and 29.8 (14.6) dB in the hydroxyapatite group (P = .18). Air-bone gap closure was 40%; it was 46.2% in the titanium group and 33.3% in the hydroxyapatite group (P = .35). CONCLUSION: Titanium is a satisfactory material for use in ossicular reconstruction and is comparable to hydroxyapatite, although at present, no definitive conclusion about the superiority of titanium can be drawn.