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Sebastian P Schraven - One of the best experts on this subject based on the ideXlab platform.
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surgical impact of coupling an active middle ear implant to short Incus process
Otology & Neurotology, 2018Co-Authors: Sebastian P Schraven, Kristen Rak, Mario Cebulla, Andreas Radeloff, Wilma Grossmann, Rudolf Hagen, Robert MlynskiAbstract:INTRODUCTION Since 1996 the active middle-ear implant Vibrant Soundbridge (VSB) is used to treat mild-to-severe sensorineural hearing losses. The former standard surgical approach for Incus vibroplasty included a mastoidectomy and a posterior tympanotomy, crimping the Floating-Mass Transducer (FMT) to the long Incus process. The introduction of the short process (SP) coupler allows the attachment of the FMT to the Incus body making the procedure of a posterior tympanotomy unnecessary. The aim of this study was to evaluate the duration of surgery (surgical case length) and to compare the audiological results of SP coupling with the former standard surgical approach to the long Incus process. MATERIALS AND METHODS Patients undergoing an Incus vibroplasty between October 2009 and February 2016 were included in this cohort study. The patients received an Incus vibroplasty with crimping the FMT to the long Incus process (former standard application) (n = 25) and with the SP coupler (n = 17) respectively. The surgical case length as well as the functional audiological outcome was assessed 12 months postoperatively using pure-tone audiometry and speech audiometry. RESULTS The surgical case length was significantly shorter in the SP coupler group compared to the standard application Incus vibroplasty (85 ± 29 min vs. 114 ± 50 min). Additionally, patients receiving the SP coupler had an increased speech perception if compared to the standard application (Freiburger monosyllables at 65 dB SPL: 76.1 ± 16.1% vs. 66.2 ± 23.5%). CONCLUSION The SP coupler leads to a shortened time of surgery and by the less invasive surgery to reduced risks for facial nerve and chorda tympani. Speech perception is significantly improved by SP coupling compared to classic long Incus coupling.
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standardized active middle ear implant coupling to the short Incus process
Otology & Neurotology, 2015Co-Authors: Robert Mlynski, Kristen Rak, Andreas Radeloff, Rudolf Hagen, Ernst Dalhoff, Daniela Wildenstein, Anthony W Gummer, Andreas Heyd, Sebastian P SchravenAbstract:INTRODUCTION Active middle-ear implants with floating-mass transducer (FMT) technology are used to treat mild-to-severe sensorineural hearing losses. The standard surgical approach for Incus vibroplasty is a mastoidectomy and a posterior tympanotomy, crimping the FMT to the long Incus process. An alternative fixation side with less surgical trauma might be the short Incus process and Incus body.The aim of this study was to develop and test a short Incus process coupling device for its functional properties in temporal bone preparations and clinical practice. MATERIALS AND METHODS An extended antrotomy and a posterior tympanotomy were performed in 10 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically, and the vibration of the stapes footplate was measured using laser Doppler vibrometry. FMT-induced vibration responses of the stapes were then measured for standard attachment at the long process and for 2 types of couplers designed for attachment at the short process of the Incus (SP1 and SP2 coupler). Additionally, the functional outcome in 2 patients provided with an SP2 coupler was assessed postoperatively at 2 weeks, 3 months, and then 11 months, using pure-tone audiometry, auditory thresholds for frequency-modulated (warble) tones, vibroplasty thresholds, and speech audiometry in quiet and noise. RESULTS For the SP2 coupler, velocity-amplitude responses in temporal-bone preparations showed generally similar mean amplitudes as compared with the standard coupling of the FMT to the long process but with clearly increased mean amplitudes between 0.7 and 1.5 kHz and with reduced interindividual variation between 0.5 and 3 kHz. The clinical data of 2 patients with mild-to-severe sensory hearing loss showed good vibroplasty thresholds and convincing results for speech audiometry in quiet (Freiburger monosyllables at 65 dB SPL, 23 ± 31% unaided versus 83 ± 4% aided) and noise (Hochmair-Schulz-Moser-test at 65 dB SPL at 10 dB SNR, 32 ± 45% unaided and 42 ± 29% aided). CONCLUSION The attachment of the FMT to the short Incus process with the SP2 coupler leads to good mechanical and functional coupling in an experimental setup and clinical practice.
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reinforced active middle ear implant fixation in Incus vibroplasty
Ear and Hearing, 2015Co-Authors: Robert Mlynski, Rudolf Hagen, Ernst Dalhoff, Daniela Wildenstein, Anthony W Gummer, Andreas Heyd, Sebastian P SchravenAbstract:OBJECTIVES The active middle ear implant Vibrant Soundbridge® was originally designed to treat mild-to-severe sensorineural hearing losses. The floating mass transducer (FMT) is crimped onto the long Incus process. The procedure is termed Incus vibroplasty to distinguish from other attachment sites or stimulus modi for treating conductive and mixed hearing losses. Rare but possible complications are difficult Incus anatomy, necrosis of the long Incus process, secondary detachment, and loosening of the FMT with concomitant amplification loss. The aim of this study was to functionally evaluate reinforcement of the standard attachment of the FMT to the long Incus process. The head of a Soft CliP® stapes prosthesis was used for reinforcement. Functional evaluation was performed in temporal-bone preparations and in clinical practice. DESIGN A subtotal mastoidectomy and a posterior tympanotomy were performed in ten fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically and the vibration of the stapes footplate and the round-window (RW) membrane, respectively, were measured by laser Doppler vibrometer (LDV). FMT-induced vibration responses of the stapes and RW were then measured for standard attachment and attachment reinforced with the head of a Soft CliP® stapes prosthesis. Additionally, the outcome in two groups of patients with Incus vibroplasty using standard and the reinforced FMT attachment were compared. Eleven patients were treated by standard coupling; nine patients obtained reinforcement with the head of the Soft CliP® stapes prosthesis. Three to six months postoperatively, auditory thresholds for frequency-modulated (warble) tones and vibroplasty thresholds for pure tones were measured. RESULTS In temporal bone, laser Doppler vibrometer measurements showed significantly enhanced vibration amplitudes of the stapes footplate and the RW membrane for the reinforced attachment compared with those for the standard attachment (on average, 5-10 dB at frequencies below 1 kHz and above 4 kHz). Interindividual amplitude variations were also smaller for reinforced attachment (on average, the standard deviation was 4-7 dB smaller). The clinical data showed lower vibroplasty thresholds for reinforced attachment compared with standard attachment, which amounted to, on average, 16 dB at 500 Hz and 12 dB at 4 kHz. CONCLUSION Auxiliary fixation of the FMT by reinforcing the attachment to the long Incus process, in these experiments with the head of a Soft CliP stapes prosthesis, leads to enhanced mechanical and functional coupling, evidenced by lower vibroplasty thresholds and increased bandwidth together with reduced variability of the vibrational frequency responses of the stapes footplate and RW membrane.
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alternative fixation of an active middle ear implant at the short Incus process
Audiology and Neuro-otology, 2014Co-Authors: Sebastian P Schraven, Rudolf Hagen, Ernst Dalhoff, Daniela Wildenstein, Anthony W Gummer, Robert MlynskiAbstract:Introduction: Since 1996, the preferred approach for positioning the active middle-ear implant Vibrant Soundbridge© is a mastoidectomy and a posterior tympanotomy. With this device, placement of the floating mass transducer (FMT) on the long Incus process is the standard method for treatment of mild-to-severe sensorineural hearing loss in the case of normal middle-ear anatomy. The aim of this study was to determine the vibrational effectiveness of FMT placement at the short Incus process. Materials and Methods: An extended antrotomy and a posterior tympanotomy were performed in 5 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically and the vibration of the stapes footplate and the round-window (RW) membrane were (sequentially) measured by laser Doppler vibrometry. Vibration responses for coupling of an FMT to the long Incus process (standard coupling) were compared to those for coupling to the short Incus process. Results: Apart from narrow frequency bands near 3 and 9 kHz for the stapes footplate and RW membrane, respectively, the velocity responses presented no significant differences between standard coupling of the FMT and coupling to the short Incus process. Conclusion: Coupling the FMT to the short Incus process may be a viable alternative in cases where the surgical approach is limited to an extended antrotomy. A reliable technique for attachment to the short Incus process has yet to be developed.
A F Sales - One of the best experts on this subject based on the ideXlab platform.
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erosion of the long process of the Incus with incomplete ossicular discontinuity in simple chronic otitis media should we reconstruct or leave it be
Clinical Otolaryngology, 2018Co-Authors: K M A Sarmento, C P De Oliveira, Andres L Sampaio, A F SalesAbstract:Objective To determine whether patients with simple chronic otitis media and incomplete ossicular discontinuity should undergo ossicular reconstruction. Design Prospective, randomized surgical trial comparing no intervention with Incus interposition over a 5-year period. Setting Tertiary referral hospital. Participants Seventy-six participants with simple chronic otitis media and erosion of the long process of the Incus but apparent good transmission throughout the ossicular chain as tested intraoperatively. Forty-four patients had partial erosion of the Incus but still bony contact with the stapes head (Group A –Type I), and 32 had mainly connective tissue binding the Incus and stapes (Group B –Type II). Each of these groups was randomized to either leaving the ossicular chain as it was (A1 and B1) or performing an Incus interposition (A2 and B2). Main outcome measures Average postoperative air bone gap and the degree of ABG closure. A postoperative air bone gap under 20 dB was considered a successful result. Results In group A, there was no significant difference between no intervention and Incus interposition. In group B, patients in the no reconstruction subgroup had a significantly worse hearing result than the Incus interposition subgroup (postoperative air bone gap of 27.5 dB and 31% closure within 20 dB versus 15 dB and 75% closure). Conclusions For Type I patients, the postoperative hearing results were similar for the reconstruction and no reconstruction groups. For Type II patients, the results clearly favor reconstruction. This article is protected by copyright. All rights reserved.
Robert Mlynski - One of the best experts on this subject based on the ideXlab platform.
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surgical impact of coupling an active middle ear implant to short Incus process
Otology & Neurotology, 2018Co-Authors: Sebastian P Schraven, Kristen Rak, Mario Cebulla, Andreas Radeloff, Wilma Grossmann, Rudolf Hagen, Robert MlynskiAbstract:INTRODUCTION Since 1996 the active middle-ear implant Vibrant Soundbridge (VSB) is used to treat mild-to-severe sensorineural hearing losses. The former standard surgical approach for Incus vibroplasty included a mastoidectomy and a posterior tympanotomy, crimping the Floating-Mass Transducer (FMT) to the long Incus process. The introduction of the short process (SP) coupler allows the attachment of the FMT to the Incus body making the procedure of a posterior tympanotomy unnecessary. The aim of this study was to evaluate the duration of surgery (surgical case length) and to compare the audiological results of SP coupling with the former standard surgical approach to the long Incus process. MATERIALS AND METHODS Patients undergoing an Incus vibroplasty between October 2009 and February 2016 were included in this cohort study. The patients received an Incus vibroplasty with crimping the FMT to the long Incus process (former standard application) (n = 25) and with the SP coupler (n = 17) respectively. The surgical case length as well as the functional audiological outcome was assessed 12 months postoperatively using pure-tone audiometry and speech audiometry. RESULTS The surgical case length was significantly shorter in the SP coupler group compared to the standard application Incus vibroplasty (85 ± 29 min vs. 114 ± 50 min). Additionally, patients receiving the SP coupler had an increased speech perception if compared to the standard application (Freiburger monosyllables at 65 dB SPL: 76.1 ± 16.1% vs. 66.2 ± 23.5%). CONCLUSION The SP coupler leads to a shortened time of surgery and by the less invasive surgery to reduced risks for facial nerve and chorda tympani. Speech perception is significantly improved by SP coupling compared to classic long Incus coupling.
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standardized active middle ear implant coupling to the short Incus process
Otology & Neurotology, 2015Co-Authors: Robert Mlynski, Kristen Rak, Andreas Radeloff, Rudolf Hagen, Ernst Dalhoff, Daniela Wildenstein, Anthony W Gummer, Andreas Heyd, Sebastian P SchravenAbstract:INTRODUCTION Active middle-ear implants with floating-mass transducer (FMT) technology are used to treat mild-to-severe sensorineural hearing losses. The standard surgical approach for Incus vibroplasty is a mastoidectomy and a posterior tympanotomy, crimping the FMT to the long Incus process. An alternative fixation side with less surgical trauma might be the short Incus process and Incus body.The aim of this study was to develop and test a short Incus process coupling device for its functional properties in temporal bone preparations and clinical practice. MATERIALS AND METHODS An extended antrotomy and a posterior tympanotomy were performed in 10 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically, and the vibration of the stapes footplate was measured using laser Doppler vibrometry. FMT-induced vibration responses of the stapes were then measured for standard attachment at the long process and for 2 types of couplers designed for attachment at the short process of the Incus (SP1 and SP2 coupler). Additionally, the functional outcome in 2 patients provided with an SP2 coupler was assessed postoperatively at 2 weeks, 3 months, and then 11 months, using pure-tone audiometry, auditory thresholds for frequency-modulated (warble) tones, vibroplasty thresholds, and speech audiometry in quiet and noise. RESULTS For the SP2 coupler, velocity-amplitude responses in temporal-bone preparations showed generally similar mean amplitudes as compared with the standard coupling of the FMT to the long process but with clearly increased mean amplitudes between 0.7 and 1.5 kHz and with reduced interindividual variation between 0.5 and 3 kHz. The clinical data of 2 patients with mild-to-severe sensory hearing loss showed good vibroplasty thresholds and convincing results for speech audiometry in quiet (Freiburger monosyllables at 65 dB SPL, 23 ± 31% unaided versus 83 ± 4% aided) and noise (Hochmair-Schulz-Moser-test at 65 dB SPL at 10 dB SNR, 32 ± 45% unaided and 42 ± 29% aided). CONCLUSION The attachment of the FMT to the short Incus process with the SP2 coupler leads to good mechanical and functional coupling in an experimental setup and clinical practice.
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reinforced active middle ear implant fixation in Incus vibroplasty
Ear and Hearing, 2015Co-Authors: Robert Mlynski, Rudolf Hagen, Ernst Dalhoff, Daniela Wildenstein, Anthony W Gummer, Andreas Heyd, Sebastian P SchravenAbstract:OBJECTIVES The active middle ear implant Vibrant Soundbridge® was originally designed to treat mild-to-severe sensorineural hearing losses. The floating mass transducer (FMT) is crimped onto the long Incus process. The procedure is termed Incus vibroplasty to distinguish from other attachment sites or stimulus modi for treating conductive and mixed hearing losses. Rare but possible complications are difficult Incus anatomy, necrosis of the long Incus process, secondary detachment, and loosening of the FMT with concomitant amplification loss. The aim of this study was to functionally evaluate reinforcement of the standard attachment of the FMT to the long Incus process. The head of a Soft CliP® stapes prosthesis was used for reinforcement. Functional evaluation was performed in temporal-bone preparations and in clinical practice. DESIGN A subtotal mastoidectomy and a posterior tympanotomy were performed in ten fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically and the vibration of the stapes footplate and the round-window (RW) membrane, respectively, were measured by laser Doppler vibrometer (LDV). FMT-induced vibration responses of the stapes and RW were then measured for standard attachment and attachment reinforced with the head of a Soft CliP® stapes prosthesis. Additionally, the outcome in two groups of patients with Incus vibroplasty using standard and the reinforced FMT attachment were compared. Eleven patients were treated by standard coupling; nine patients obtained reinforcement with the head of the Soft CliP® stapes prosthesis. Three to six months postoperatively, auditory thresholds for frequency-modulated (warble) tones and vibroplasty thresholds for pure tones were measured. RESULTS In temporal bone, laser Doppler vibrometer measurements showed significantly enhanced vibration amplitudes of the stapes footplate and the RW membrane for the reinforced attachment compared with those for the standard attachment (on average, 5-10 dB at frequencies below 1 kHz and above 4 kHz). Interindividual amplitude variations were also smaller for reinforced attachment (on average, the standard deviation was 4-7 dB smaller). The clinical data showed lower vibroplasty thresholds for reinforced attachment compared with standard attachment, which amounted to, on average, 16 dB at 500 Hz and 12 dB at 4 kHz. CONCLUSION Auxiliary fixation of the FMT by reinforcing the attachment to the long Incus process, in these experiments with the head of a Soft CliP stapes prosthesis, leads to enhanced mechanical and functional coupling, evidenced by lower vibroplasty thresholds and increased bandwidth together with reduced variability of the vibrational frequency responses of the stapes footplate and RW membrane.
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alternative fixation of an active middle ear implant at the short Incus process
Audiology and Neuro-otology, 2014Co-Authors: Sebastian P Schraven, Rudolf Hagen, Ernst Dalhoff, Daniela Wildenstein, Anthony W Gummer, Robert MlynskiAbstract:Introduction: Since 1996, the preferred approach for positioning the active middle-ear implant Vibrant Soundbridge© is a mastoidectomy and a posterior tympanotomy. With this device, placement of the floating mass transducer (FMT) on the long Incus process is the standard method for treatment of mild-to-severe sensorineural hearing loss in the case of normal middle-ear anatomy. The aim of this study was to determine the vibrational effectiveness of FMT placement at the short Incus process. Materials and Methods: An extended antrotomy and a posterior tympanotomy were performed in 5 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically and the vibration of the stapes footplate and the round-window (RW) membrane were (sequentially) measured by laser Doppler vibrometry. Vibration responses for coupling of an FMT to the long Incus process (standard coupling) were compared to those for coupling to the short Incus process. Results: Apart from narrow frequency bands near 3 and 9 kHz for the stapes footplate and RW membrane, respectively, the velocity responses presented no significant differences between standard coupling of the FMT and coupling to the short Incus process. Conclusion: Coupling the FMT to the short Incus process may be a viable alternative in cases where the surgical approach is limited to an extended antrotomy. A reliable technique for attachment to the short Incus process has yet to be developed.
Alexander M. Huber - One of the best experts on this subject based on the ideXlab platform.
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biocompatibility of nitinol stapes prosthesis
Otology & Neurotology, 2011Co-Authors: Christof Roosli, Philipp Schmid, Alexander M. HuberAbstract:OBJECTIVE: Use of the SMart piston, a nitinol-based, self-crimping prosthesis in stapes surgery may allow improved functional results because of better sound transmission properties at the Incus-prosthesis interface because of the elimination of manual crimping. Possible disadvantages include thermal damage or strangulation of the Incus and its mucoperiosteum or nickel intolerance. The goal of this study was to morphologically assess the fixation of this prosthesis to the Incus, investigate the reaction of the middle ear mucosa to the prosthesis, identify alterations to the incudal bone, and detect deposits of nickel in the tissue around the prosthesis. STUDY DESIGN:: Prospective consecutive case analysis. SETTING:: Tertiary referral center. PATIENTS: Four patients with an unfavorable functional result after primary SMart-piston stapedotomy. INTERVENTION: Revision malleostapedotomy with explantation of the Incus and prosthesis for further analysis. MAIN OUTCOME MEASURES: Analysis of intraoperative findings and postoperative examination of the explants using light- and scanning-electron microscopy, energy dispersive x-ray analysis, and atom absorption spectrometry. RESULTS:: The intraoperative, macroscopic, and scanning electron microscopic investigation showed tight circular fixation of the prostheses, whereas a gap between the prosthesis and the lateral Incus was found in 1 case. All prostheses were overgrown by mucosa. Superficial localized erosion of the incudal bone was found in 2 cases. There was no elevation in nickel content in the removed tissue samples. CONCLUSION:: The lateral gap between prosthesis and Incus did not affect fixation of the prosthesis, neither did covering by a mucosal layer. Bone erosion was most likely caused by laser in one and by the prosthesis in another explant. No signs of increased nickel deposits could be found on energy dispersive x-ray analysis or atom absorption spectrometry. We conclude that a nitinol stapes prosthesis is safe for treatment of stapedial fixation.
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The influence of postoperative tissue formation on sound transmission after stapes surgery.
Hearing Research, 2010Co-Authors: Michail Chatzimichalis, Alexander M. HuberAbstract:Abstract In the surgical treatment of otosclerosis, the coupling between the stapes prosthesis and the long process of the Incus is critical. After surgery, connective tissue and mucosa may grow over the coupling area and thereby influence the sound transmission properties of the Incus–prosthesis interface. It was the hypothesis of this study that tissue ongrowth in the Incus–prosthesis interface has little influence on sound transmission following stapes surgery. The goals of the study were to: (1) investigate the extent of postoperative tissue ongrowth over the stapes prosthesis; (2) objectively evaluate intra- and postoperative sound transmission properties of revision stapes surgery and compare the findings to those from primary surgery; (3) quantify the influence of ongrown tissue on sound transmission after stapes surgery. A group of 10 patients undergoing revision stapes surgery was investigated with audiological evaluations and intraoperative laser Doppler interferometry, and with scanning electron microscopy of the explanted Incus with its adherent prosthesis in 6 patients. Results were compared to a group of patients undergoing primary otosclerosis surgery and temporal bone experiments. Results indicated that tissue grows over the prosthesis, as identified in all specimens. Sound transmission properties were evaluated intraoperatively (i.e., Incus mobility and prosthesis-fixation quality), and found to correlate well with the functional hearing results. Ongrowing mucosa in the Incus–prosthesis interface had only a minimal effect on sound transmission properties and cannot compensate adequately for insufficient prosthesis fixation. Therefore, it is essential that the stapes prosthesis is properly fixed during primary otosclerosis surgery.
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malleostapedotomy in revision surgery for otosclerosis
Otology & Neurotology, 2001Co-Authors: Ugo Fisch, Gul Ozbilen Acar, Alexander M. HuberAbstract:PURPOSE: The purpose of this study was to analyze the results of malleostapedotomy and to compare them with those of a conventional Incus stapedotomy in a series of 82 consecutive surgical revisions in otosclerotic patients. MATERIALS AND METHODS: 82 consecutive revision stapes surgery cases over 5 years were evaluated. The preoperative and postoperative audiometric data of 80 (97.5%) of the patients were obtained. RESULTS: 71 of the patients underwent a functional revision procedure as malleostapedotomy (56, 79%) or as Incus stapedotomy (15, 21%). The most common cause of failure of primary surgery was a displaced or malfunctioning prosthesis (86.2%). Pathologic changes of the oval window were found in 80% of the cases. Problems of the Incus were identified in 80% and abnormality of the malleus in 48.6% of the cases. The functional success rate of malleostapedotomy (closure within 10 dB) was found to be higher than that of traditional Incus stapedotomy (p < 0.05). Overclosure was seen in 12 patients (17%) and a significant sensorineural hearing loss in 2 patients (3%). There were no dead ears in this series. The postoperative hearing results after first revision surgery were better than those after multiple surgical procedures (p < 0.05). CONCLUSIONS: Malleostapedotomy yields better functional hearing results than Incus stapedotomy in revision surgery for otosclerosis. The detection of many malleus fixations was the result of the systematic exposure of the anterior malleal process and ligament through an endaural approach with superior canaloplasty.
K M A Sarmento - One of the best experts on this subject based on the ideXlab platform.
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erosion of the long process of the Incus with incomplete ossicular discontinuity in simple chronic otitis media should we reconstruct or leave it be
Clinical Otolaryngology, 2018Co-Authors: K M A Sarmento, C P De Oliveira, Andres L Sampaio, A F SalesAbstract:Objective To determine whether patients with simple chronic otitis media and incomplete ossicular discontinuity should undergo ossicular reconstruction. Design Prospective, randomized surgical trial comparing no intervention with Incus interposition over a 5-year period. Setting Tertiary referral hospital. Participants Seventy-six participants with simple chronic otitis media and erosion of the long process of the Incus but apparent good transmission throughout the ossicular chain as tested intraoperatively. Forty-four patients had partial erosion of the Incus but still bony contact with the stapes head (Group A –Type I), and 32 had mainly connective tissue binding the Incus and stapes (Group B –Type II). Each of these groups was randomized to either leaving the ossicular chain as it was (A1 and B1) or performing an Incus interposition (A2 and B2). Main outcome measures Average postoperative air bone gap and the degree of ABG closure. A postoperative air bone gap under 20 dB was considered a successful result. Results In group A, there was no significant difference between no intervention and Incus interposition. In group B, patients in the no reconstruction subgroup had a significantly worse hearing result than the Incus interposition subgroup (postoperative air bone gap of 27.5 dB and 31% closure within 20 dB versus 15 dB and 75% closure). Conclusions For Type I patients, the postoperative hearing results were similar for the reconstruction and no reconstruction groups. For Type II patients, the results clearly favor reconstruction. This article is protected by copyright. All rights reserved.
