Learning objectives:
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1. Understand the variability that ensues during crimping of stapes prostheses
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2. Understand the benefits conferred by self-crimping shape memory prostheses
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3. Learn about long term stability of hearing outcomes using self-crimping shape memory prostheses
Introduction: Self-crimping stapes pistons were introduced to remove the manual component of the crimping process during stapedectomy with a view to producing stable long term hearing improvement in a reproducible manner and reducing trauma to the middle and inner ear. The objective of this study was to assess the long term clinical hearing outcomes and their stability following stapedectomy using a self-crimping shape memory Nitinol prosthesis over a 10 year period.
Methods: Retrospective case review was performed in a tertiary referral centre. Thirteen adult patients underwent fourteen stapedectomy procedures using a self-crimping shape memory Nitinol prosthesis between November 2003 and February 2005. Pure tone audiometry was performed preoperatively, at three monthly intervals up to two years and at five and ten years postoperatively.
Results: Mean postoperative air conduction (0.5, 1, 2 and 3kHz) was 24.4 dB (standard deviation 8.3) at 1 year and 29.6 dB (11.2) at 10 years. Mean postoperative bone conduction (0.5, 1, 2 and 3kHz) was 18.6 (8.0) at 1 year and 25.0 (12.0) at 10 years. Mean postoperative air bone gap (0.5, 1, 2 and 3kHz) was 5.5 dB (3.0) at 1 year and 4.8 dB (3.9) at 10 years. Mean air bone gap closure was 23.3 (12.6) at 1 year and 24.2 (9.9) at 10 years. Mean change in high tone bone conduction level (1, 2 and 4kHz) was 5.4 dB (6.0) at 1 year and -0.2 dB (7.0) at 10 years, a mean deterioration of 5.6 dB (0.6 dB per year).
Conclusions: Excellent closure of the air bone gap is demonstrated and it remains stable over at least ten years. There is no evidence that circumferential firm fixation of the prosthesis hook around the long process of incus has a detrimental effect in the long term.
