gms | German Medical Science

Introduction: Long term hearing improvement after middle ear reconstruction depends on Material used to reconstruct, design of the prosthesis and long term stability of the implant. The biggest problem of Total prosthesis is to stabilize it on the foot plate. Not only is it difficult to position the implant during surgery but due to middle ear forces the chances of prosthesis getting shifted at a later date is very high.

Methods: Titanium spider is made in a shape of a ring with six ‘feet’ which rest on the foot plate. Through the ring total prosthesis is passed which rests directly on the foot plate. The stabilized prosthesis remains perpendicular to the foot plate and the Spider ‘Shoe’ holds it in position and prevents it from shifting during healing process.

Results: Twenty two cases were operated in which the spider shoe was used. The follow up varied between two years to three months. Out of twenty two patients seven patients were revision surgeries due to unsatisfactory hearing results. Fifteen patients were for primary surgeries out of which 12 patients had cholesteatoma and three patients had large central perforation.

The average improvement of hearing was 35 db. Due to post operative infection in one patient the prosthesis along with the spider shoe got extruded within first 4 weeks.

Conclusion: With introduction of Spider ‘shoe’ stabilizer autologist has a chance to stabilize a total implant. Compared to cartilage shoe (Hüttenbrink) the Spider ‘shoe’ is simpler to place on the foot plate, has no chance of resoption. With the use of spider shoe the total implant comes in direct contact with the foot plate which is better for sound energy transfer.