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Initial Experience with Titanium MVP Clip Prosthesis

Singh P. P.

Published: MEMRO 2006, 4th International Symposium on Middle Ear
Mechanics in Research and Otology: Selected Abstracts

Introduction: After introduction of stapes surgery malleovestibulopexy
(MVP) was the natural extention of this procedure. Although the hearing
results of stapes surgery were usually excellent, the hearing results of
MVP were quite variable. This probably resulted from poor understanding
of middle ear mechanics and usage of the same prosthesis as used for stapes
surgery. Modification of prosthesis design and technique has resulted
in improved hearing outcomes after this procedure.

Purpose: To evaluate the hearing outcomes of malleovestibulopexy using
titanium MVP clip prosthesis which has recently been introduced.

Material and Methods: Six patients undergoing exploratory tympanotomy
for congenital conductve hearing loss or failed stapes surgery and requiring
malleovestibulopexy are included in this study. Extended tympanomeatal
flap was employed for exposure of middle ear and upper malleus handle. The
prosthesis was introduced and the clip was slipped on malleus handle. Minor
adjustments were required to attain the perpendicularity of the shaft and shaft
insertion in the vestibule. Drilling of handle with diamond burr was required
in half the cases to better adapt the clip on malleus handle.

Results: The mean of air-bone gap averaged over speech frequencies was
within 20 dB in all six cases and within 10 dB in four cases. No deterioration
of bone conduction threshold was observed.

Conclusions: The hearing resuts of malleovestibulopexy using newly introduced
titanium MVP clip prosthesis have been encouraging and almost
equal results of stapes surgery. The improved results seem to be consequent
to the unique design of the prosthesis which factors in two key variables of
this procedure viz anchorage of prosthesis on malleus handle and perpendicularity
of the prosthesis shaft in relation to stapes footplate.