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Effect of Ossicular Prosthesis Biofilms on Middle Ear Scarring and Hearing Outcomes

Jaryszak, Eric M.; Sampson, Edith M.; Antonelli, Patrick J.

doi: 10.1097/MAO.0b013e3181be64b3
Middle Ear and Mastoid Disease

Objectives: Microbial biofilms have been associated with poor outcomes with a variety of biomedical implants; however, this relationship has not been established with ossicular chain reconstruction prostheses (ORPs). The purpose of this study was to determine if biofilms are present on ORPs in patients undergoing revision ossicular chain reconstruction and if their presence correlates with middle ear scarring or hearing outcomes.

Study Design: Prospective and blinded.

Setting: Tertiary referral center.

Patients: Patients undergoing revision ossicular chain reconstruction with previous ORP placement were enrolled.

Intervention/Main Outcome Measure: Ossicular chain reconstruction prostheses associated with poor hearing and residual or recurrent disease were cultured and examined using scanning electron microscopy. Audiometric thresholds and middle ear scarring scores were recorded.

Results: Twelve patients were included in the study. Of the prostheses, 25% were culture positive, and 67% had microscopic evidence of biofilm. No difference was found between the middle ear scarring scores (p = 0.31) and hearing outcomes (p = 0.11) of biofilm and nonbiofilm prostheses. There was no correlation between middle ear scarring and degree of conductive hearing loss (R2 = 0.04; p = 0.54).

Conclusion: Biofilms are commonly found on ORPs at the time of revision ossicular chain reconstruction. The interaction between biofilms and the host environment is complex. Many factors besides biofilms may impact middle ear scarring and hearing.

Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida, U.S.A.

Address correspondence and reprint requests to Patrick J. Antonelli, M.D., Department of Otolaryngology, University of Florida, Box 100264, 1600 SW Archer Road, Gainesville, FL 32610-0264; E-mail:

Presented at the American Otological Society Annual Meeting, May 29-30, 2009, Phoenix, AZ.

Disclosures: Eric M. Jaryszak M.D., Ph.D.: Stryker 2006, 2007 Resident Travel grant awardee; Medtronic ENT grant support. Patrick J. Antonelli, M.D.: Sharklet Technologies LLC grant support; Medtronic ENT grant support, paid consultant.

© 2009 Otology & Neurotology, Inc.