BIOMATERIALS IN OTOLOGY Biomaterials in Otology Proceedings of the First International Symposium 'Biomaterials in Otology', April 21-23, 1983, Leiden, The Netherlands edited by J.J. GROTE, MD Professor of Otolaryngology, ENT-Department, University Hospital, Leiden, The Netherlands 1984 MARTIN US NIJHOFF PUBLISHERS .~1.1 a member of the KLUWER ACADEMIC PUBLISHERS GROUP BOSTON / THE HAGUE / DORDRECHT / LANCASTER .~ Distributors jor the United States and Canada: Kluwer Boston, Inc., 190 Old Derby Street, Hingham, MA 02043, USA jorall other countries: Kluwer Academic Publishers Group, Distribution Center, P.O.Box 322, 3300 AH Dordrecht, The Netherlands Library of Congress Cataloging in Publication Data International Symposium "Biomaterials in Otology" Ust : 1983 : Leiden, Netherlands) Biomaterials in otology. Includes index. 1. Middle ear--Surgery--Congresses. 2. Implants, Artificial--Materials--Congresses. 3. Biomedical materials--Congresses. 4. Surgery, Plastic--Congresses. 1. Grote, J. J. II. Title. [DNLM: 1. Ear, Middle- Surgery--Congresses. 2. Implants, Artificial- Congresses. 3. Biocompatible materials--Congresses. W3 IN909M 1st 1983b / WV 230 1595 1983b] RF126.157 1983 617.8'0028 83-21951 ISBN-13: 978-94-009-6758-8 e-ISBN-13: 978-94-009-6756-4 DOl: 10.1007/978-94-009-6756-4 Copyright © 1984 by Martinus Nijhoff Publishers, Boston. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publishers, Martinus Nijhoff Publishers, 190 Old Derby Street, Hingham, MA 02043, USA. v Preface The need for better implant materials was a stimulus for the increa sing knowledge of Biomaterial Scientists. Different surgical disciplines were very successful in the use of prostheses, especially because they based their surgery on a good cooperation with fundamental scientists. The use of alloplastic implant materials in the reconstruction of the middle ear has not always been successful. We all know the initial suc cess in the sixties and the disappointments after short term follow-up periods. Because of these failures, Otology missed contact with the new developments in Biomaterial Science. However, we must realize that in the reconstruction of a sound conducting system our most successful results are achieved with alloplastic implants. John Shea introduced the use of Teflonprostheses in the restoration of hearing in otosclerosis and ever since this has been the most rewarding reconstructive middle ear opera tion. With the development of the intact canal wall techniques and the use of homologous implant materials the problems of middle ear surgery see med to be solved. However, we now know that closed techniques have dis advantages after longer post-operative periods and the use of homologous implant materials give problems. Collection of these implants is not al ways easy and the preservation is still in discussion. Furthermore, pro blems of resorption, rejection or fixation give uncertain post-operative results. Middle ear prostheses of different new implant materials are promoted by industry and good results are published, but also disappointments after shorter or longer periods. This was the reason to organize a scientific meeting in which Otolo gists and Biomaterial scientists came together. It is time for a criti cal evaluation of the possibilities and limitations of new implants, in order to benefit of the increasing knowledge in this field, as other surgical disciplines have done. This book gives the presentations of the First International Symposium Biomaterials in Otology, held in the Netherlands April 21-23, 1983. The fundamental aspects and the surgery with different plastic and cera mic implants were discussed. VI The presentations were made by speakers from allover the world, in dicating the inbernational interest in this field. It was an honour to have as a special guest in this symposium Prof.Dr. H.L.Wullstein who was the first to use an alloplastic implant in the development of his Tympanoplasty techniques. I hope that the combination of the different disciplines and the often opposing opinions concerning materials and surgery give up to date infor mation. With the problems of the past and the possibilities and limita tions of the present we have to evaluate the future of Biomaterials in Otology. J.J.Grote, M.D. Leiden, May 1983 VII TABLE OF CONTENTS PREFACE J.J. Grote, M.D., Leiden, the Netherlands - V AUTHORS - XI I HISTORY OF MIDDLE EAR It1PLANTS D.Plester, M.D. - 1 II FUNDAr~ENTAL ASPECTS - 7 - On alloplasts for otoloqy. - 9 Charles A.Homsy, Sc.D. Behaviour of bioimplants in the middle ear. - 18 W.Kuypers, Ph.D. Tissue response to porous materials used for ossicular replacement prostheses. - 29 M.Spector, Pr.D., J.F.Teichgraeber, M.D., J.H. Per-Lee, M.D., R.T.Jackson, Ph.D. - The closure of dural defects with Proplast. - 41 Rick Clark, M.D., Jon Robertson, M.D. John J.Shea, M.D., Koichi Tomoda, M.D. - Ceramic implant materials, possible applications and their limits. - 50 G.Heimke, Ph.D. - Bioglass implants for otology. - 62 L.L.Hench, Ph.D., June Wilson, Ph.D. G.Merwin, M.D. _ Macor ceramics in soft and hard tissue. - 70 M.Pauler, M.D., H.Plenck, M.D. Histological studies on the suitability of macor-ceramic implants. - 74 K.Jahnke, M.D., C.Schmidt, M.D. Calciumphosphate ceramics: Biomaterials for middle ear implants. - 80 K. de Groot, Ph.D. _ Biodegradation of calciumphosphate ceramics-ultrastructural geometry and dissolubility of different calciumphosphate ceramics. - 84 Christel P.A.T.Klein, Ph.D., Klein, Ph.D., A.A.Driessen, Ph.D., K. de Groot, Ph.D. VIII Hydroxyapatite in the infected middle ear. - 93 C.A. van Blitterswijk, Ph.D., J.J.Grote, M.D., W.Kuypers, Ph.D. An electrocochleographic study of the effect of plaster of Paris implanted in the middle ear of the guinea pig. - 105 O.Hogset, M.D., G.Bredberg, M.D. H.Ericson, M.D., B.Lindstrom, M.D. III PLASTIC IMPLANTS - 117 Columellar tympanoplasty. - 119 David F.Austin, M.D. TORPS and PORPS: Personal experiences - 127 A report on 446 operations. James L.Sheehy, M.D. Polyethylene TORPS and PORPS in otologic surgery. - 137 J.J.Shea, M.D., J.R.Emmett, M.D. Plastipore TORP with peg. - 153 J.J.Shea, M.D. PORPs and TORPs versus allografts after five years. - 155 G.D.L.Smyth, M.D. Proplast and Plastipore in the middle ear. - 161 A.G.Kerr, M.D., G.P.Brennan, M.D., G.D.L.Smyth, M.D. Causes of ossiculoplasty failure using porous polyethylene (Plasti-Pore) prostheses. - 169 N.J.Frootko, M.D. Comparative study of different ossicular prostheses in tympanoplasty (Proplast, Plastipore, Ceravital). Analysis of clinical results, histopathological and hearing in the long term (250 cases). - 177 M.Portmann, M.D., J.P.Bebear, M.D., M.Bagot d'Arc, M.D., A.Diogo de Paiva, M.D. Plastipore prostheses for ossicular chain reconstruction in tympanoplasty. - 187 M.Sanna, M.D., R.Gamoletti, M.D. M.Magnani, M.D., C.Zini, M.D. IX The histologic appearance of Plastipore ossicular prostheses. - 199 R.Gamoletti, M.D., M.Sanna, M.D. A.Bellomi, M.D., C.Zini, ~1.D. IV CERAMIC IMPLANTS - 203 Otologic surgery with aluminiumoxide ceramic implants. - 205 K.Jahnke, M.D. Aluminium ceramics as columella materials in ossicular reconstruction. - 210 E.Yamamoto, M.D., M.Iwanaga, M.D. Current status of the development of Bioglass ossicular replacement implants. - 220 G.E.Merwin, M.D., June Wilson, Ph.D. L.L.Hench, Ph.D. Fundamental aspects of Bioglass and surgery with bioactive glass ceramic implants. - 230 R.Reck, M.D., J.Helms, M.D. Our experience with Ceravital implants in middle ear surgery. (A middle term evaluation). - 242 G.Babighian, M.D. Macor ceramics in the middle ear. H.Hamersma, M.D., H.G.Engelbrecht, M.D. Further observations on application of "Plasticin" in ear surgery. - six years of experience - 250 S.R.Wullstein, M.D., K.Schindler, Ph.D. W.Doll, M.D. Are porous, tricalciumphosphate ceramic implants suitable for middle ear surgery? An experimental study of the pig's hypotympanon, with additional preliminary clinical results. - 262 Ch.Zollner, M.D., :I.Strutz, M.D. ChI. Beck, M.D., C.M.BUsing, M.D. Tympanoplasty with calciumphosphate. - 274 J.J.Grote Use of sintered hydroxylapatite and inert collagen in middle ear surgery. - 281 S.Funasaka, M.D., K.Matsumoto, M.D. x Three years of experience with ceramic prosthesis. - 290 C.W.Jansen, M.D. Ceramics in the reconstruction of the middle ear. - 294 J.Bosch, M.D. Fibrinogen glue and biocompatible prostheses. - 299 J.P.Bebear, ·M.D., M.Bagot d'Arc, M.D. A.Diogo de Paiva, M.D., J.Petit, M.D. V MATERIALS - 303 INDEX - 307 XI AUTHORS AUSTIN D.F., M.D. Austin Otologic Center, 55 East Washington S.C., Chicago Illinois 60602, U.S.A. BABIGHIAN G., M.D. Istituti Ospedalieri di Trento, Divisione di Otorinolaringoiatria, Trento, Italy BAGOT D'ARC M., M.D. ENT-Department, University of Bordeaux II, Bordeaux, France BEBEAR J.P., M.D. ENT-Department, University of Bordeaux II, Bordeaux, France BECK CHL., M.D. ENT-Department, University of Freiburg, Killianstrasse 5, Freiburg, W.Germany BELLOMI A., M.D. Servizio Anatomica Pathologica, Ospedale Maggiore, Lodi, Italy BLITTERSWIJK C.A. VAN., Ph.D. ENT-Department, University Hospital Leiden, Rijnsburgerweg 10, 2333 AA Leiden, the Netherlands BREDBERG G., M.D. Department of Audiology, Soder Hospital, Sodersjukhuset 10064, Stockholm 38, Sweden BRENNAN G.P., M.D. Eye and Ear Clinic, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland BOSCH J., M.D. ENT-Department, Hospital Cruz Roja, Herzegovino 15, Barcelona, Spain BUSING C.M., M.D. ENT-Department, University of Freiburg, Killianstrasse 5, Freiburg, W.Germany CLARK R., M.D. Shea Clinic, 1080 Madison Square, Memphis Tennessee 38163, U.S.A. DIOGO DE PAIVA A., M.D. ENT-Department, University of Bordeaux II, France DOLL W., Ph. D• Institute of Hygiene and Microbiology, University of WUrzburg, D-8700 WUrzburg, W.Germany DRIESSEN A.A., Ph.D. Department of Material Science, Free University of Amsterdam, de Boele laan 1117, 1007 MC Amsterdam, the Netherlands EMMETT J.R., M.D. Shea Clinic, 1080 Madison Square, Memphis Tennessee 38163, U.S.A. ENGELBRECHT H.G., M.D. ENT -Department, ENT -hospital, 333 Skinnerstreet, Pretoria 0002, S.Africa