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.