MIDDLE EAR IMPLANTSMIDDLE EAR IMPLANTS

DR.RADHAMADHAB SAHUDR.RADHAMADHAB SAHUDR.RAJEEV KUMARDR.RAJEEV KUMAR

DR.S.MANDALDR.S.MANDAL

Principle of tympanoplastyPrinciple of tympanoplastySound protection of round window Sound protection of round window Sound – Pressure transformation for the Sound – Pressure transformation for the

oval windowoval window

Classification of TympanoplastyClassification of TympanoplastyWullstein (1956)Wullstein (1956)

Type I tympanoplasty Type I tympanoplasty TM is grafted to an intact ossicular chainTM is grafted to an intact ossicular chain

Type II tympanoplasty Type II tympanoplasty Malleus is partially eroded Malleus is partially eroded TM +/- malleus remnant is grafted to the incusTM +/- malleus remnant is grafted to the incus

Type III tympanoplasty (myringostapediopexy) Type III tympanoplasty (myringostapediopexy) Malleus and incus are erodedMalleus and incus are erodedTM is grafted to the stapes suprastructureTM is grafted to the stapes suprastructureResults in shallow middle earResults in shallow middle earColumella effect i.e a single bone in middle ear to transmit sound Columella effect i.e a single bone in middle ear to transmit sound

from eac.from eac.

Classification of TympanoplastyClassification of Tympanoplasty Wullstein classification continued…Wullstein classification continued…

Type IV tympanoplastyType IV tympanoplastyStapes suprastructure is eroded but foot plate is Stapes suprastructure is eroded but foot plate is

mobile which is kept exposed.mobile which is kept exposed.Tissue graft bridges hypotympanum and round Tissue graft bridges hypotympanum and round

window,exteriorise OW – cavum minor.window,exteriorise OW – cavum minor.Type V TympanoplastyType V Tympanoplasty

TM is grafted to a fenestration in the horizontal TM is grafted to a fenestration in the horizontal semicircular canalsemicircular canal

Classification does not take into account Classification does not take into account middle ear pathologymiddle ear pathology

SCHUKNECHT CLASSIFICATION – SCHUKNECHT CLASSIFICATION – I – Repair of TMI – Repair of TM II – GRAFT BETWEEN LONG PROCESS II – GRAFT BETWEEN LONG PROCESS

OF INCUS AND STAPES HEADOF INCUS AND STAPES HEAD IIIA – STAPES COLUMELLA – TM IIIA – STAPES COLUMELLA – TM

GRAFT ON INTACT STAPES HEADGRAFT ON INTACT STAPES HEAD

IIIB – Minor columella – TM graft and a cartilage strut on stapes capitulum (porp)

TYPE III C – Major columella – strut between tm graft and stapes footplate - torp

HISTORY HISTORY

1958-SHEA –POLYTHENE PROSTHESIS 1958-SHEA –POLYTHENE PROSTHESIS IN REPLACEMENT OF STAPES CURAEIN REPLACEMENT OF STAPES CURAE

1960-69-HARRISON USED INCUS 1960-69-HARRISON USED INCUS REPLACEMENT REPLACEMENT PROSTHESIS(POLYTHENE)PROSTHESIS(POLYTHENE)

1980-USE OF CERAMIC STARTED 1980-USE OF CERAMIC STARTED 1987-WEHR INCUS PROSTHESIS MADE 1987-WEHR INCUS PROSTHESIS MADE

OF HYDROXYAPATITE.OF HYDROXYAPATITE.

HISTORYHISTORY1990-GOLDENBERG DEVLOPED 1990-GOLDENBERG DEVLOPED

HYBRIDE PROSTHESIS SYSTEM.HYBRIDE PROSTHESIS SYSTEM.1992-USE OF GLASS IONOMER 1992-USE OF GLASS IONOMER

CEMENT STARTEDCEMENT STARTED1992-MAGNAN CONSTRUCTED TORP 1992-MAGNAN CONSTRUCTED TORP

AND PORP PROSTHESIS ENTIERLY AND PORP PROSTHESIS ENTIERLY MADE UP OF TITANIUMMADE UP OF TITANIUM

4 types4 types Biotolerant-Biotolerant-they do not bond with bone but a layer of they do not bond with bone but a layer of

fibrous tissue at their interfacefibrous tissue at their interface Bio-inert- Bio-inert- no exchange of ions but contact is no exchange of ions but contact is

maintainedmaintained Bioreactive- Bioreactive- ionic and covalent bonds are formedionic and covalent bonds are formed Bioactive- Bioactive- chemical reaction at their interface chemical reaction at their interface

resulting in strong bonding osteogenesisresulting in strong bonding osteogenesis

BIOMATERIALS USED FOR BIOMATERIALS USED FOR IMPLANTSIMPLANTS

BiotolerantBiotolerant

Bio-inertBio-inert

BioreactiveBioreactive

BioactiveBioactive

polyethenepolyetheneFirst prosthesis to be used.First prosthesis to be used.Mostly used as incus replacement Mostly used as incus replacement

prosthesis, stapes-malleus prosthesis,.prosthesis, stapes-malleus prosthesis,.Advantage -:easily cut in to proper shape.Advantage -:easily cut in to proper shape.Disadvantage-:extrusion rate was Disadvantage-:extrusion rate was

extremely high 30-50% in first year and extremely high 30-50% in first year and 70% within the first three years.70% within the first three years.

INCUS REPLACEMENT INCUS REPLACEMENT PROSTHESISPROSTHESIS

SLIT FOR STAPES

SUNFLOWER SHAPED PLATFORM GROOVE FOR MALLEUS

STAPES-MALLEUS STAPES-MALLEUS PROSTHESISPROSTHESIS

FOR MALLEUS MUSHROOM TYPE PLATFORM

TEFLONTEFLON Solid polymer made up of polytetrafluro Solid polymer made up of polytetrafluro

ethylene.ethylene. Widely used in stapedectomyWidely used in stapedectomy In tympanoplasty as porp,torpIn tympanoplasty as porp,torp low cost, good plastic memorylow cost, good plastic memory loop diameter 0.6mmloop diameter 0.6mm Functional length 4-4.5mmFunctional length 4-4.5mm Piston diameter 0.6mm Piston diameter 0.6mm Disadvantage : necrosis of long process of Disadvantage : necrosis of long process of

incus , stiffness of prosthesisincus , stiffness of prosthesis

Porous polythenePorous polythene Porous polythene prosthesis ( TORP & Porous polythene prosthesis ( TORP &

PORP) introduced by Shea in 1974PORP) introduced by Shea in 1974 Includes proplast,teflon plus vitrified Includes proplast,teflon plus vitrified

carbon,plasti-pore,pure polythene,polycel.carbon,plasti-pore,pure polythene,polycel. The essential property is porous structure The essential property is porous structure

which enables them in principle to be which enables them in principle to be infiltrated by living tissue, leading to effective infiltrated by living tissue, leading to effective integration and bio-compactibility. integration and bio-compactibility.

Success improved by interposing a cartilage Success improved by interposing a cartilage between TM and prosthesis described by between TM and prosthesis described by sheehysheehy

Porous polythenePorous polytheneAdvantage:-less extrusion rate(3-5%) as Advantage:-less extrusion rate(3-5%) as

compairision to polyethylenecompairision to polyethyleneUsed as a material for combination Used as a material for combination

prosthesis.prosthesis.Easy to shape.Easy to shape.Disadvantage:- extrusion, biodegradation.Disadvantage:- extrusion, biodegradation.

PORP & TORPPORP & TORP

Extruding prosthesisExtruding prosthesis

TORP using cartilage stiffenerTORP using cartilage stiffener

Plastipore and PolycelPlastipore and Polycel In the late 1970s, a high-density polyethylene In the late 1970s, a high-density polyethylene

sponge (HDPS) that had nonreactive properties sponge (HDPS) that had nonreactive properties was developed. HDPS has sufficient porosity to was developed. HDPS has sufficient porosity to encourage tissue ingrowth. encourage tissue ingrowth.

The original form was a machined-tooled The original form was a machined-tooled prosthesis (Plasti-Pore); a more versatile prosthesis (Plasti-Pore); a more versatile manufactured thermal-fused HDPS (Polycel) manufactured thermal-fused HDPS (Polycel) arrived later. This latter form permitted coupling arrived later. This latter form permitted coupling with other materials, such as stainless steel, with other materials, such as stainless steel, thus lending itself to a wide variety of prosthetic thus lending itself to a wide variety of prosthetic designs. designs.

Plastipore and PolycelPlastipore and PolycelClinical experience has shown the Clinical experience has shown the

necessity of covering these HDPS necessity of covering these HDPS alloplasts with cartilage to minimize the alloplasts with cartilage to minimize the incidence of extrusion. Extrusion rates incidence of extrusion. Extrusion rates have averaged 3-5% in large series with 5-have averaged 3-5% in large series with 5-10 years of follow-up monitoring. 10 years of follow-up monitoring.

MULTI-PORP

SHEEHY’S PORP PROSTHESIS

Off-Centered PORPOff-Centered PORPTMTM Prosthesis(PLASTI-PORE)Prosthesis(PLASTI-PORE)

Sheehy’s prosthesis

PLASTI-POREPLASTI-POREThe Off-Centered Plasti-Pore PORPThe Off-Centered Plasti-Pore PORPTMTM is is

completely cannulated, allowing the completely cannulated, allowing the surgeon visibility of the suprastructure of surgeon visibility of the suprastructure of the stapes during surgery. The position of the stapes during surgery. The position of the shaft permits a direct, rather than the shaft permits a direct, rather than angled, stapes to tympanum placement. angled, stapes to tympanum placement.

ceramicsceramicsCeramics are non organic crystalline Ceramics are non organic crystalline

materialsmaterialsGood thermal insulator but they are fragileGood thermal insulator but they are fragileTheir porosity varies from 5-Their porosity varies from 5-

600micrometer600micrometerAt least 100micrometer diameter is At least 100micrometer diameter is

required for bone tissue to invade in to required for bone tissue to invade in to ceramicsceramics

BIOINERT CERAMICSBIOINERT CERAMICSFrilalit(aluminium dioxide) introduced by Frilalit(aluminium dioxide) introduced by

Jahnke et al in 1979.Jahnke et al in 1979.Bioceram (kyocera company) introduced Bioceram (kyocera company) introduced

by Yamamoto in1982by Yamamoto in1982

FRIALITFRIALITShaft is a tube , should be should be Shaft is a tube , should be should be

shortened to a proper length with a shortened to a proper length with a diamond drill under constant irrigation.diamond drill under constant irrigation.

First generation:-straight hollow shaped First generation:-straight hollow shaped with round headswith round heads

PORP

FRIALITFRIALITSecond generation:-with grooves in the Second generation:-with grooves in the

oval shaped platforms and small hole in oval shaped platforms and small hole in the side of hollow shaft , facilitate in-the side of hollow shaft , facilitate in-growth of fibrous tissuegrowth of fibrous tissue

BIOCERAMBIOCERAMCeramic ossicular replacement prosthesis-Ceramic ossicular replacement prosthesis-

partial. CORP-Ppartial. CORP-PCeramic ossicular replacement prosthesis-Ceramic ossicular replacement prosthesis-

total. CORP-Ttotal. CORP-TSmooth surface Smooth surface Extrusion rate is 8%.Extrusion rate is 8%.

CORP-P

HydroxyapatiteHydroxyapatite

Hydroxylapatite is another bioactive Hydroxylapatite is another bioactive

material used for middle ear material used for middle ear

reconstruction. The nonporous and reconstruction. The nonporous and

homogenous nature of dense homogenous nature of dense

hydroxylapatite resists penetration by hydroxylapatite resists penetration by

granulation tissue. granulation tissue.

HydroxyapatiteHydroxyapatite

Hydroxylapatite is a polycrystalline calcium Hydroxylapatite is a polycrystalline calcium

phosphate ceramic that has the same phosphate ceramic that has the same

chemical composition as bone. chemical composition as bone.

It forms a direct bond with bone at the It forms a direct bond with bone at the

hydroxylapatite/tissue interface. hydroxylapatite/tissue interface.

HydroxyapatiteHydroxyapatiteWith time, hydroxylapatite implants With time, hydroxylapatite implants

gradually become completely covered by gradually become completely covered by an epithelial layer. The final epithelial layer an epithelial layer. The final epithelial layer contains all cell types characteristic for the contains all cell types characteristic for the middle ear. indicating good middle ear. indicating good biocompatibility of the implant material.biocompatibility of the implant material.

Hydroxyapatite prosthesisHydroxyapatite prosthesis BiocompatibleBiocompatible Similar to bone in weight and physical Similar to bone in weight and physical

characteristicscharacteristics Could be sculptured to any shapeCould be sculptured to any shape Good resultsGood results Disadvantage-Disadvantage-diff size and shape- combination had to be diff size and shape- combination had to be

made. Brittle & insufficient tensile strength , slightly biodegradable.made. Brittle & insufficient tensile strength , slightly biodegradable.

Hydroxyapatite prosthesisHydroxyapatite prosthesis

HAPEXHAPEX

. HAPEX is a composite material made of . HAPEX is a composite material made of 40% hydroxylapatite and 60% 40% hydroxylapatite and 60% polyethylene by volume. By weight, polyethylene by volume. By weight, HAPEX is more than 70% hydroxylapatite. HAPEX is more than 70% hydroxylapatite. Unlike hydroxylapatite, which is brittle and Unlike hydroxylapatite, which is brittle and difficult to trim, HAPEX and fluoroplastic difficult to trim, HAPEX and fluoroplastic are trimmed easily with a scalpel.are trimmed easily with a scalpel.

HAPEXHAPEX

Two partsTwo parts Portion of it touching malleus and tympanic memb- HydroxyapatitePortion of it touching malleus and tympanic memb- Hydroxyapatite Middle ear part touching stapes and stapedial foot plate- HAPEX – Middle ear part touching stapes and stapedial foot plate- HAPEX –

could be cut to length with a knifecould be cut to length with a knife

4 basic types4 basic types IncusIncus Incus stapesIncus stapes Single notchSingle notch Double notchDouble notch

HAPEXHAPEX

This SIngle Notch Prosthesis is This SIngle Notch Prosthesis is applicable when the "offset" from applicable when the "offset" from the head of the stapes to the the head of the stapes to the malleus handle is estimated to be malleus handle is estimated to be from 2.0 to 3.0 mm. Lesser or from 2.0 to 3.0 mm. Lesser or greater distances require the use greater distances require the use of a Double Notch Prosthesis. of a Double Notch Prosthesis.

Combination prosthesisCombination prosthesisGoldenberg prosthesis-hydroxyapatite Goldenberg prosthesis-hydroxyapatite

head and plastipore shaft.head and plastipore shaft.Blackspanner prosthesis-hydroxyapatite Blackspanner prosthesis-hydroxyapatite

head and plastipore shaft.head and plastipore shaft.Teflon shaft and polycel head.Teflon shaft and polycel head.Advantage:-plastipore as shaft easy to Advantage:-plastipore as shaft easy to

shape,hydroxyapetite and polycel as head shape,hydroxyapetite and polycel as head has less extrusion rate. has less extrusion rate.

GLASS INOMER CEMENTGLASS INOMER CEMENT Obtained by reaction of glass powder by Obtained by reaction of glass powder by

polyacrylic acid.polyacrylic acid. Using the cement paste two ossicles can be Using the cement paste two ossicles can be

connected , defective long process of incus connected , defective long process of incus can be restored.can be restored.

Good compactibility ,rapidly covered by Good compactibility ,rapidly covered by middle ear mucosa , no biodegradability.middle ear mucosa , no biodegradability.

Geyer and Helms in 1990 studied 90 patients Geyer and Helms in 1990 studied 90 patients with no extrusion rates.with no extrusion rates.

GLASS INOMER CEMENTGLASS INOMER CEMENT

PORP

TitaniumTitanium Titanium is another common alloplastic Titanium is another common alloplastic

material. Studies in rabbits have shown that material. Studies in rabbits have shown that within 28 days after implantation, a thin, within 28 days after implantation, a thin, noninflamed, even layer of epithelium forms noninflamed, even layer of epithelium forms over the inserted implant. Similar results in over the inserted implant. Similar results in human studies have shown the same type of human studies have shown the same type of reactivity. Titanium forms a biostable titanium reactivity. Titanium forms a biostable titanium oxide layer when combined with oxygen. oxide layer when combined with oxygen.

The properties of titanium make it possible to The properties of titanium make it possible to manufacture an extremely fine and light manufacture an extremely fine and light prosthesis with substantial rigidity in the shaft. prosthesis with substantial rigidity in the shaft.

TitaniumTitaniumFurthermore, differential processing of the Furthermore, differential processing of the

material surfaces triggers various tissue material surfaces triggers various tissue reactions. For example, rough-milled reactions. For example, rough-milled surfaces are most appropriate in areas surfaces are most appropriate in areas that contact cartilage or the stapes head or that contact cartilage or the stapes head or footplate. footplate.

Conversely, the smoother the surface, the Conversely, the smoother the surface, the less connective tissue reaction occurs, less connective tissue reaction occurs, and the epithelial covering is minimized.and the epithelial covering is minimized.

TitaniumTitaniumAs far back as 1993, a group of surgeons As far back as 1993, a group of surgeons

designed the total (Arial) prosthesis and designed the total (Arial) prosthesis and the partial (Bell) prosthesis.the partial (Bell) prosthesis.

These are available commercially from These are available commercially from Kurz.Kurz.

In 1996, Spiggle and Theis introduced new In 1996, Spiggle and Theis introduced new titanium prostheses that can be trimmed titanium prostheses that can be trimmed intraoperatively to the appropriate lengthintraoperatively to the appropriate length

BENEFITSBENEFITS Small mass for good sound transmissionSmall mass for good sound transmission Careful weight balance results in efficient intraoperative Careful weight balance results in efficient intraoperative

handlinghandling Large surface contact with the tympanic membrane or Large surface contact with the tympanic membrane or

transplant prevents tiltingtransplant prevents tilting Partially roughened surface stabilizes prosthesis placementPartially roughened surface stabilizes prosthesis placement Excellent biocompatibility for irritant-free integration into the Excellent biocompatibility for irritant-free integration into the

middle earmiddle ear Individual shape adaptation through simple bending Individual shape adaptation through simple bending Well documented by scientific studiesWell documented by scientific studies MRI compactible.MRI compactible.

TTP™ - Tuebingen Titanium TTP™ - Tuebingen Titanium Prosthesis AERIAL / BELLProsthesis AERIAL / BELL

Low input impedance and stable conduction features improve sound transmissionExcellent visualization for insertion and placement because of the open headplate and delicate designIndividual shape adaptation through simple bending.

Duesseldorf Type Titanium Duesseldorf Type Titanium Prostheses BELL (partial) and Prostheses BELL (partial) and

AERIAL (totalAERIAL (total

Regensburg Type Titanium Regensburg Type Titanium Total ProsthesisTotal Prosthesis

BENEFITSBENEFITS

The shaft is made of Grade 2 The shaft is made of Grade 2 Titanium with outstanding Titanium with outstanding malleability. Tests have shown malleability. Tests have shown that the prosthesis stem can be that the prosthesis stem can be bent up to 100 times before risk of bent up to 100 times before risk of fracturing. fracturing.

BENEFITSBENEFITS0.2 mm shaft of pure titanium for 0.2 mm shaft of pure titanium for

maximum adaptability to patient’s middle maximum adaptability to patient’s middle ear anatomyear anatomy

Fenestrated headplate with notches for Fenestrated headplate with notches for precise positioning of the oval stemprecise positioning of the oval stem

Partially roughened surface to improve Partially roughened surface to improve implant stability on the stapes footplateimplant stability on the stapes footplate

MNP - Malleus Notch MNP - Malleus Notch ProsthesisProsthesis

BENEFITSBENEFITSNotch headplate eliminates intraoperative Notch headplate eliminates intraoperative

implant bending for malleus adjustmentimplant bending for malleus adjustmentProven prosthesis design for a secure Proven prosthesis design for a secure

connection to the malleus handleconnection to the malleus handleExcellent biocompatibilityExcellent biocompatibilityUltra light weightUltra light weightThe open headplate design facilitates The open headplate design facilitates

implant placement and handlingimplant placement and handling

Length Variable Titanium Length Variable Titanium Prostheses Prostheses 

TTP™-VARIO System TTP™-VARIO System Instrument SetInstrument Set

BENEFITSBENEFITS

Only one variable prosthesis is required as Only one variable prosthesis is required as a partial or total prosthesisa partial or total prosthesis

The prostheses have no limiting sleeve The prostheses have no limiting sleeve along the shaft - for unequalled length along the shaft - for unequalled length variability and malleabilityvariability and malleability

Spacing in 0.25 mm increments offers Spacing in 0.25 mm increments offers optimal length choices and flexibility optimal length choices and flexibility

Shortest partial prosthesis length 1.75 mmShortest partial prosthesis length 1.75 mm(Functional Length FL 0.75 mm)(Functional Length FL 0.75 mm)

TTP-VARIAC™ SystemTTP-VARIAC™ System

Determination of prosthesis Determination of prosthesis length:length:

Using the sizers that are attached to the Using the sizers that are attached to the central disk, the optimal prosthesis length central disk, the optimal prosthesis length can be determined quickly, precisely and can be determined quickly, precisely and reliably. The sizer’s lightweight and reliably. The sizer’s lightweight and delicate design allows for easy handling, delicate design allows for easy handling, even balance and an unobstructed view of even balance and an unobstructed view of the middle ear.the middle ear.

Adjusting the prosthesis Adjusting the prosthesis length: length:

Depth gage sockets of varying depths are Depth gage sockets of varying depths are arranged in a circular pattern on the arranged in a circular pattern on the sizerdisk. These sockets are used to hold sizerdisk. These sockets are used to hold the prosthesis while adjusting its length. the prosthesis while adjusting its length. The headplate of the prosthesis is The headplate of the prosthesis is fastened to the shaft using the patented fastened to the shaft using the patented proven locking mechanismproven locking mechanism

BENEFITSBENEFITS The prostheses have no limiting sleeve along the shaft The prostheses have no limiting sleeve along the shaft

- for unequalled length variability and malleability- for unequalled length variability and malleability The integrated sizer disk with its five functions The integrated sizer disk with its five functions

eliminates potentially unsafe sizing with actual implant eliminates potentially unsafe sizing with actual implant and reduces necessary instrumentation to a minimumand reduces necessary instrumentation to a minimum

Exact determination of optimal prosthesis length using Exact determination of optimal prosthesis length using integrated sizersintegrated sizers

Single-use product - no costly cleaning and Single-use product - no costly cleaning and resterilizationresterilization

A pin on the headplate fixes the interface transplant A pin on the headplate fixes the interface transplant and thus prevents dislocation of the prosthesisand thus prevents dislocation of the prosthesis

CliP® Partial Prosthesis CliP® Partial Prosthesis Dresden Type TitaniumDresden Type Titanium

CliP® Partial Prosthesis CliP® Partial Prosthesis Dresden Type TitaniumDresden Type Titanium

The method of secure coupling of the The method of secure coupling of the CliP® Partial Prosthesis is revolutionary: A CliP® Partial Prosthesis is revolutionary: A tensile, seven-pronged clip is simply tensile, seven-pronged clip is simply clipped onto the stapes capitulum . Due to clipped onto the stapes capitulum . Due to its built-in resilience it creates a very its built-in resilience it creates a very stable intraoperative situation for stable intraoperative situation for reconstructing the tympanic membrane reconstructing the tympanic membrane and an excellent auditory transmission and an excellent auditory transmission chain.chain.

CliP® Partial Prosthesis CliP® Partial Prosthesis Dresden Type TitaniumDresden Type Titanium

With this new ossicular With this new ossicular coupling technique, the risk coupling technique, the risk of postoperative implant of postoperative implant dislocation with resulting dislocation with resulting hearing impairment is hearing impairment is almost impossiblealmost impossible

CliP® Partial Prosthesis CliP® Partial Prosthesis Dresden Type TitaniumDresden Type Titanium

CliP Partial FlexiBAL®CliP Partial FlexiBAL®

CliP Partial FlexiBAL®CliP Partial FlexiBAL® CliP Partial FlexiBAL®, with a micro ball joint in CliP Partial FlexiBAL®, with a micro ball joint in

the headplate. The mobile joint causes the the headplate. The mobile joint causes the headplate to move with the tympanic headplate to move with the tympanic membrane. Tests have validated that these membrane. Tests have validated that these movements do not mitigate acoustic movements do not mitigate acoustic effectiveness as the prosthesis headplate and effectiveness as the prosthesis headplate and the CliP® remain in stable contact with the the CliP® remain in stable contact with the tympanic membrane and the stapes capitulum.tympanic membrane and the stapes capitulum.

BENEFITSBENEFITS Integrated micro ball joint automatically adjusts Integrated micro ball joint automatically adjusts

prosthesis headplate to angle of tympanic prosthesis headplate to angle of tympanic membrane during placementmembrane during placement

Automatic and continual postoperative position Automatic and continual postoperative position rebalancing in response to minute changes in the rebalancing in response to minute changes in the tympanic angle ensures optimal prosthesis tympanic angle ensures optimal prosthesis placement and effectivenessplacement and effectiveness

Standardized safe coupling on stapes capitulum Standardized safe coupling on stapes capitulum with proven CliP® Designwith proven CliP® Design

Pure titanium for maximum biocompatibilityPure titanium for maximum biocompatibility

Ω Ω CONNECTORCONNECTOR

Ω Ω CONNECTORCONNECTOR

PROSTHESES OVER PROSTHESES OVER CONNECTORCONNECTOR

MECHANISMMECHANISM Ω CONNECTOR used inΩ CONNECTOR used in the appropriate the appropriate

spatial conditionsspatial conditions in the oval niche, this in the oval niche, this optional base provides maximum contact with optional base provides maximum contact with the stapes footplate. It is connected to the the stapes footplate. It is connected to the prosthesis shaft with a micro ball joint. The prosthesis shaft with a micro ball joint. The resulting flexible joint connection is adjustable resulting flexible joint connection is adjustable in all directions and may overcome varying in all directions and may overcome varying spatial alignments of footplate and tympanic spatial alignments of footplate and tympanic membrane or malleusmembrane or malleus

DIMENSIONSDIMENSIONSThe Ω CONNECTOR can be used with all The Ω CONNECTOR can be used with all

KURZ® Total Prostheses whose shafts KURZ® Total Prostheses whose shafts end in a circular stem with 0.8 mm end in a circular stem with 0.8 mm diameter. The functional length of the Ω diameter. The functional length of the Ω CONNECTORS is 0.5 mm. It is sterile and CONNECTORS is 0.5 mm. It is sterile and individually packagedindividually packaged

BENEFITSBENEFITSMicro ball jointMicro ball joint

Flexible connection is adjustable in all Flexible connection is adjustable in all directionsdirectionsCan balance spatial alignmentsCan balance spatial alignments

Large contact area with the stapes Large contact area with the stapes footplate for more stabilityfootplate for more stability

Angular CliP® ProsthesisAngular CliP® Prosthesis

Angular CliP® ProsthesisAngular CliP® ProsthesisThe innovative Angular CliP® The innovative Angular CliP®

Prosthesis standardizes the Prosthesis standardizes the connection to the stapes connection to the stapes capitulum. The built-in resilience capitulum. The built-in resilience of its eight prongs assures a of its eight prongs assures a secure fit even in cases of less secure fit even in cases of less than ideal positioningthan ideal positioning

Angular CliP® ProsthesisAngular CliP® Prosthesisthis prosthesis was designed to:-this prosthesis was designed to:-Simplify the surgical procedure Simplify the surgical procedure

when bridging defects of the when bridging defects of the lenticular processlenticular process

Reduce the risk of implant Reduce the risk of implant dislocationdislocation

BENEFITSBENEFITSSelf-retaining on the stapes capitulumSelf-retaining on the stapes capitulumLow weight for optimal sound conductionLow weight for optimal sound conductionProven CliP® designProven CliP® designStandardized and simple coupling on the Standardized and simple coupling on the

stapes capitulumstapes capitulumExcellent biocompatibility for irritant-free Excellent biocompatibility for irritant-free

integration into the middle earintegration into the middle earPure titaniumPure titanium

Angular Prosthesis Plester Angular Prosthesis Plester TitaniumTitanium

MECHANISMMECHANISM

The Angular Prosthesis Plester enables the The Angular Prosthesis Plester enables the integrity of the auditory ossicular chain to be integrity of the auditory ossicular chain to be restored in the event of destruction of the restored in the event of destruction of the distal end of the long process of the incus. distal end of the long process of the incus. The two titanium bands play the role of a The two titanium bands play the role of a clamp and are attached to the incus. The bell clamp and are attached to the incus. The bell fits onto the stapes capitulum. The pure fits onto the stapes capitulum. The pure mechanical connection of the titanium bands mechanical connection of the titanium bands with the incus is very stablewith the incus is very stable

BENEFITSBENEFITSLight weight for optimal sound conductionLight weight for optimal sound conductionExcellent acoustical transmissionExcellent acoustical transmission

KURZ® IBP - Incus Bridge KURZ® IBP - Incus Bridge ProsthesisProsthesis

KURZ® IBP - Incus Bridge KURZ® IBP - Incus Bridge ProsthesisProsthesis

The titanium clamps at either end of the The titanium clamps at either end of the prosthesis create a secure mechanical prosthesis create a secure mechanical bond with the incus remnant and the bond with the incus remnant and the stapes capitulumstapes capitulum

BENEFITSBENEFITSMaximized visibilityMaximized visibilityLow weight for optimal sound conductionLow weight for optimal sound conductionSecure placementSecure placementSimple couplingSimple coupling

K-Piston with LoopK-Piston with Loop

BENEFITSBENEFITSLow weightLow weightStable fitStable fitReduced necrosis risk due to extra Reduced necrosis risk due to extra

wideloop bandwideloop bandAtraumatic designAtraumatic design In case of a narrow incus the off-centered In case of a narrow incus the off-centered

loop is easy to close and allows for a loop is easy to close and allows for a perfect fit around the incusperfect fit around the incus

Soft CliP® PISTONSoft CliP® PISTON

Soft CliP® PISTONSoft CliP® PISTONSafe and secure fixation onto the long Safe and secure fixation onto the long

process of the incus is accomplished process of the incus is accomplished without insecure crimping, making the without insecure crimping, making the CliP® principle one of the most efficient CliP® principle one of the most efficient and effective solutions for Stapedioplastyand effective solutions for Stapedioplasty

Soft CliP® PISTONSoft CliP® PISTON Self-retaining CliP® designSelf-retaining CliP® design

Standardized and safe coupling onto the long process of the Standardized and safe coupling onto the long process of the incus without insecure crimpingincus without insecure crimping

Contact-free zones along the long process of the incusContact-free zones along the long process of the incusPrevent mucosa strangulation: Risk reduction for incus Prevent mucosa strangulation: Risk reduction for incus necrosisnecrosis

Contact zones medial and lateralContact zones medial and lateralOptimize acoustic transmission (FSound) and therefore Optimize acoustic transmission (FSound) and therefore hearing resultshearing results

Wide CliP® bandsWide CliP® bandsAvoid high pressure points and related risks of mucosa Avoid high pressure points and related risks of mucosa damage "snowshoe effect"damage "snowshoe effect"

Reduction of CliP® extension for easier fixation even in tight Reduction of CliP® extension for easier fixation even in tight middle earsmiddle ears

CliP® Piston àWengen CliP® Piston àWengen Titanium Stapes ProsthesisTitanium Stapes Prosthesis

BENEFITSBENEFITS Self-retaining CliP® designSelf-retaining CliP® design Low weightLow weight No crimpingNo crimping Secure placementSecure placement Reduced risk of necrosisReduced risk of necrosis Improved vascular supply of incus and Improved vascular supply of incus and

lenticular processlenticular process Excellent biocompatibilityExcellent biocompatibility

CliP® Piston MVP Haeusler CliP® Piston MVP Haeusler DesignDesign

Titanium Stapes Prosthesis Titanium Stapes Prosthesis for Malleovestibulopexyfor Malleovestibulopexy

Advanced micro ball joint design Advanced micro ball joint design For optimal intraoperative adjustmentFor optimal intraoperative adjustment

Proven CliP® designProven CliP® design For a secure, crimpfree connection to the For a secure, crimpfree connection to the malleus handlemalleus handle

Pure Titanium implant materialPure Titanium implant materialFor excellent biocompatibilityFor excellent biocompatibility

Lightweight Lightweight For optimal sound conductionFor optimal sound conduction

Angular PistonAngular Piston

Angular PistonAngular PistonThe indication for the Angular Piston is The indication for the Angular Piston is

erosion of the long process of the incus erosion of the long process of the incus and the impossibility of attaching a and the impossibility of attaching a conventional piston to it. This occurs conventional piston to it. This occurs mostly during revision surgery after mostly during revision surgery after stapedioplasty, when bone necrosis of the stapedioplasty, when bone necrosis of the process of the incus is present in the area process of the incus is present in the area of the piston loop.of the piston loop.

Angular PistonAngular Piston

The two titanium bands play the The two titanium bands play the role of a clamp and are attached role of a clamp and are attached to the shortened long process of to the shortened long process of the incus. The long wire end the incus. The long wire end corresponds to the piston of a corresponds to the piston of a standard stapes prosthesisstandard stapes prosthesis

KRAUS K-HELIXKRAUS K-HELIXNormal anatomy is preserved.Normal anatomy is preserved.Climping technique may cause delayed Climping technique may cause delayed

pressure necrosis.pressure necrosis.Optional cement application enhances Optional cement application enhances

prosthesis stability during healing.prosthesis stability during healing.

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