Gestörtes HörenChirurgische Verfahren

T. Zahnert

doi:10.1055/s-2005-861139

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2005; 84: 37-53
DOI: 10.1055/s-2005-861139

Gestörtes Hören

Gestörtes Hören
Chirurgische Verfahren

T. Zahnert¹

¹ Universitäts-HNO-Klinik Dresden (Direktor: Priv.-Doz. Dr. med. Dr. h. c. T. Zahnert)

Abstract

Zusammenfassung

Die Wiederherstellung der Hörfunktion ist in vielen Fällen mit einer Resozialisierung der Betroffenen verbunden und nimmt deshalb in einer Gesellschaft mit immer schneller werdender Kommunikation einen wichtigen Platz ein. Nicht alle Probleme lassen sich auf chirurgischem Weg lösen. Auch 50 Jahre nach Einführung der Tympanoplastik sind die Hörergebnisse unbefriedigend und erreichen häufig nicht die Schwelle zum sozialen Gehör. Als Ursache dafür kann in den meisten Fällen eine unvollständige Wiederherstellung der Schleimhautfunktion des Mittelohres und der Tube angesehen werden, die zu Belüftungsstörungen des Ohres führt und eine regelrechte Schwingung des rekonstruierten Mittelohres nicht erlaubt. Einige Ursachen liegen jedoch auch in der Biomechanik der rekonstruierten Kette begründet. Es gibt heute Fortschritte in der rekonstruktiven Mittelohrchirurgie, die sich vor allem auf die Weiterentwicklung von Implantaten beziehen. Dabei können Implantate aus Titan als eine neue Generation betrachtet werden, die sich durch eine hervorragende Biokompatibilität, ein graziles Design und durch neue biomechanische Möglichkeiten in der Wiederherstellung der Kettenfunktion auszeichnen. Metallimplantate erlauben erstmalig einen kontrollierten Kraft- und Formschluss an den verbliebenen Rest der Kette sowie die Integration mikromechanischer Funktionen in das Implantat. Darüber hinaus gibt es auch Fortschritte in der Mikrochirurgie selbst. Diese betreffen vor allem das operative Vorgehen bei Gehörgangsatresie, bei der Wiederherstellung des Trommelfells und der Ankopplung von Implantaten. Das vorliegende Referat gibt einen Überblick über den derzeitigen Stand der rekonstruktiven Mittelohrchirurgie unter Beachtung der akusto-mechanischen Gesetzmäßigkeiten.

Schlüsselwörter

Mittelohrchirurgie - Mittelohrrekonstruktion - Tympanoplastik - Stapesplastik - Gehörgangsplastik - Mittelohrimplantat - Gehörgangsatresie

Full Text

References

Literatur

1 Shaw E AG. Eardrum representation in middle-ear acoustical networks. Meet Acoust Soc Am. 1977; 94
2 Helmholtz H. Die Lehre von der Tonempfindung;. 1862
3 Trendelenburg F. Einführung in die Akustik, 3. Aufl. ed. Berlin/Göttingen/Heidelberg; Springer 1961
4 Ackley R S, Traynor R M. Measurement of ear canal resonance. Hearing Instruments. 1989; 40 11
5 Rodriguez Jorge J, Zenner H P, Hemmert W, Burkhardt C, Gummer A W. Laservibrometrie. HNO. 1997; 45 997-1007
6 Hartwein J. Untersuchungen zur Akustik der offenen Mastoidhöhle (sog. „Radikalhöhle”) und deren Beeinflußbarkeit durch chirurgische Maßnahmen. Teil II: Klinische Untersuchungen. Laryngo-Rhino-Otol. 1992; 71 453-461
7 Molvaer O I, Vallersnes F M, Kringlebotn M. The size of the middle ear and the mastoid air cell. Acta Otolaryngol. 1978; 85 24-32
8 Rosowski J J, Merchant S N. Mechanical and acoustic analysis of middle ear reconstruction. Am J Otol. 1995; 16 486-497
9 Mercke U. The cholesteatomatous ear one year after surgery with obliteration technique. Am J Otol. 1987; 8 534-536
10 Palva P. Surgical Treatment of Chronic Middle Ear Disease. Acta Otolaryngol (Stockholm). 1987; 104 279-284
11 Hartwein J. Untersuchungen zur Akustik der offenen Mastoidhöhle (sog. „Radikalhöhle”) und deren Beeinflußbarkeit durch chirurgische Maßnahmen. Teil I: Physikalische Grundlagen, experimentelle Untersuchungen. Laryngo-Rhino-Otol. 1992; 71 401-406
12 Satar B, Yetiser S, Ozkaptan Y. Evolving acoustic characteristics of the canal wall down cavities due to neo-osteogenesis by periosteal flap. Otol Neurotol. 2002; 23 845-849
13 Mahendran S, Yung M W. Mastoid obliteration with hydroxyapatite cement: the Ipswich experience. Otol Neurotol. 2004; 25 19-21
14 Roberson J B , Mason T P, Stidham K R. Mastoid obliteration: autogenous cranial bone pAte reconstruction. Otol Neurotol. 2003; 24 132-140
15 Tsai T L, Lien C F, Guo Y C. Mastoid-obliteration surgery with cartilage for suppurative cholesteatomatous ears. Zhonghua Yi Xue Za Zhi (Taipei). 2002; 65 523-528
16 Soo G, Tong M C, van Hasselt C A. Mastoid obliteration and lining using the temporoparietal fascial flap. Laryngoscope. 1997; 107 1674
17 Moffat D A, Gray R F, Irving R M. Mastoid obliteration using bone pate. Clin Otolaryngol. 1994; 19 149-157
18 East C A, Brough M D, Grant H R. Mastoid obliteration with the temporoparietal fascia flap. J Laryngol Otol. 1991; 105 417-420
19 Chang S O, Min Y G, Kim C S, Koh T Y. Surgical management of congenital aural atresia. Laryngoscope. 1994; 104 606-611
20 House H P. Management of congenital ear canal atresia. Laryngoscope. 1953; 63 916-946
21 Bauer G P, Wiet R J, Zappia J J. Congenital aural atresia. Laryngoscope. 1994; 104 1219-1224
22 McKinnon B J, Jahrsdoerfer R A. Congenital auricular atresia: update on options for intervention and timing of repair. Otolaryngol Clin North Am. 2002; 35 877-890
23 Cole R R, Jahrsdoerfer R A. Congenital aural atresia. Clin Plast Surg. 1990; 17 367-371
24 Chandrasekhar S S, de la Cruz A, Garrido E. Surgery of congenital aural atresia. Am J Otol. 1995; 16 713-717
25 Crabtree J A. Congenital atresia: case selection, complications, and prevention. Otolaryngol Clin North Am. 1982; 15 755-762
26 Bellucci R J. Congenital Aural Malformations: Diagnosis and Treatment. Otolaryngol Clin North Am. 1981; 14 95-124
27 Jahrsdoerfer R A, Yeakley J W, Aguilar E A, Cole R R, Gray L C. Grading system for the selection of patients with congenital aural atresia. Am J Otol. 1992; 13 6-12
28 Lambert P R. Congenital aural atresia: stability of surgical results. Laryngoscope. 1998; 108 1801-1805
29 De la Cruz A, Linthicum F H , Luxford W M. Congenital atresia of the external auditory canal. Laryngoscope. 1985; 95 421-427
30 Minatogawa T, Nishimura Y, Inamori T, Kumoi T. Results of tympanoplasty for congenital aural atresia and stenosis, with special reference to fascia and homograft as the graft material of the tympanic membrane. Laryngoscope. 1989; 99 632-638
31 Schuknecht H F. Congenital aural atresia. Laryngoscope. 1989; 99 908-917
32 Jahrsdoerfer R A. Congenital atresia of the ear. Laryngoscope. 1978; 88 1-48
33 Sperling N M, Kay D. Diagnosis and management of the lateralized tympanic membrane. Laryngoscope. 2000; 110 1987-1993
34 Yotsuyanagi T, Urushidate S, Nihei Y, Yokoi K, Sawada Y. Reconstruction of congenital stenosis of external auditory canal with a postauricular chondrocutaneous flap. Plast Reconstr Surg. 1998; 102 2320-2324
35 Chang S O, Jeon S J, Jeong H S, Kim C S. Prevention of postoperative meatal stenosis with anteriorly and inferiorly based periosteal flaps in congenital aural atresia surgery. Otol Neurotol. 2002; 23 25-28
36 Bell D R. External auditory canal stenosis and atresia: dual flap surgery. J Otolaryngol. 1988; 17 19-21
37 Dhooge I J, Vermeersch H F. The use of two pedicled skin flaps in the surgical treatment of acquired atresia of the outer ear canal. Clin Otolaryngol. 1999; 24 58-60
38 Furuta S, Noguchi M, Takagi N. Reconstruction of stenotic external auditory canal with a postauricular chondrocutaneous flap. Plast Reconstr Surg. 1994; 94 700-704
39 Siegert R, Weerda H. Two-step external ear canal construction in atresia as part of auricular reconstruction. Laryngoscope. 2001; 111 708-714
40 Siegert R. Combined reconstruction of congenital auricular atresia and severe microtia. Laryngoscope. 2003; 113 2021-2027; discussion 2028 - 2029
41 Jahrsdoerfer R A. The facial nerve in congenital middle ear malformations. Laryngoscope. 1981; 91 1217-1225
42 Lambert P R, Dodson E E. Congenital malformations of the external auditory canal. Otolaryngol Clin North Am. 1996; 29 741-760
43 Altmann F. Congenital atresia of the ear in man and animals. Ann Otol Rhinol Laryngol. 1955; 64 824-858
44 Gill N W. Congenital atresia of the ear. A review of the surgical findings in 83 cases. J Laryngol Otol. 1969; 83 551-587
45 Siegert R, Weerda H, Mayer T, Bruckmann H. High resolution computerized tomography of middle ear abnormalities. Laryngo-Rhino-Otol. 1996; 75 187-194
46 Mattox D E, Fisch U. Surgical correction of congenital atresia of the ear. Otolaryngol Head Neck Surg. 1986; 94 574-577
47 Jahrsdoerfer R A, Hall J W 3rd. Congenital malformations of the ear. Am J Otol. 1986; 7 267-269
48 Rosowski J J. The effects of external and middle ear filtering on auditory threshold and noise induced hearing loss. J Acoust Soc Am 90. 1991; 90 124-135
49 Austin D F. Acoustic mechanisms in middle ear sound transfer. Otolaryngologic Clinics of North America. 1994; 27 641-654
50 Peake W T, Rosowski J J, Lynch T J. Middle-ear transmission: acoustic versus ossicular coupling in cat and human. Hear Res. 1992; 57 245-268
51 Wever E G, Lawrence M. Physiological Acoustics. In: Princeton University Press Princeton; 1954
52 Merchant S-N, McKenna M J, Rosowski J-J. Current status and future challanges of tympanoplasty. Eur Arch Otolaryngol. 1998; 255 221-228
53 Mürbe D, Zahnert T, Bornitz M, Hüttenbrink K B. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope. 2002; 112 1769-1776
54 Dornhoffer J L. Hearing Results With Cartilage Tympanoplasty. Laryngoscope. 1997; 107 1094-1099
55 Hüttenbrink K-B. Zur Rekonstruktion des Schallleitungsapparates unter biomechanischen Gesichtspunkten. Laryngo-Rhino-Otol. 2000; 79 23-51
56 Hüttenbrink K-B. Die operative Behandlung der chronischen Otitis media. I-III. HNO. 1994; 42 582-593, 648 - 657, 701 - 718
57 Hildmann H, Sudhoff H, Jahnke K. Grundzüge einer differenzierten Cholesteatomchirurgie. Laryngo-Rhino-Otol. 2000; Suppl. 2 73-94
58 Jahnke K. Fortschritte in der Mikrochirurgie des Mittelohres. HNO. 1987; 35 1-13
59 Stage J, Bak-Pedersen K. Underlay tympanoplasty with the graft lateral to the malleus handle. Clin Otolaryngol. 1992; 17 6-9
60 Kartush J M, Michaelides E M, Becvarovski Z, LaRouere M J. Over-under tympanoplasty. Laryngoscope. 2002; 112 802-807
61 Karlan M S. Gelatin film sandwich in tympanoplasty. Otolaryngol Head Neck Surg. 1979; 87 84-86
62 Schwaber M K. Postauricular undersurface tympanic membrane grafting: some modifications of the “swinging door” technique. Otolaryngol Head Neck Surg. 1986; 95 182-187
63 Williams J D. Microclip application in tympanoplasty. Ann Otol Rhinol Laryngol. 1977; 86 223-226
64 Liew L, Daudia A, Narula A A. Synchronous fat plug myringoplasty and tympanostomy tube removal in the management of refractory otorrhoea in younger patients. Int J Pediatr Otorhinolaryngol. 2002; 66 291-296
65 Kartush J M. Tympanic membrane Patcher: a new device to close tympanic membrane perforations in an office setting. Am J Otol. 2000; 21 615-620
66 McFeely W J , Bojrab D I, Kartush J M. Tympanic membrane perforation repair using AlloDerm. Otolaryngol Head Neck Surg. 2000; 123 17-21
67 Wiegand H. Tympanic membrane repair with cartilage and double tissue-layered grafts (author’s transl). HNO. 1978; 26 233-236
68 Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope. 1993; 103 1352-1356
69 Amedee R G, Mann W J, Riechelmann H. Cartilage palisade tympanoplasty. Am J Otol. 1989; 10 447-450
70 Neumann A, Schultz-Coulon H J, Jahnke K. Type III tympanoplasty applying the palisade cartilage technique: a study of 61 cases. Otol Neurotol. 2003; 24 33-37
71 Müller J, Schön F, Helms J. Realities in tympanplasty. In: Hüttenbrink K-B (Hrsg). Middle ear mechanics in research and otosurgery University Press Dresden; 1997: 151-157
72 Schöttke H, Hartwein J, Pau H W. Einfluß unterschiedlicher Transplantatmaterialien bei der Tympanoplastik Typ 1 auf den Schalldruckpegel im Gehörgang. OtoRhinoLaryngol Nova. 1992; 2 318-320
73 Zahnert T, Bornitz M, Hüttenbrink K-B. Akustische und mechanische Eigenschaften von Trommelfelltransplantaten. Laryngo-Rhino-Otol. 1997; 76 717-723
74 Heermann J, Heermann H, Kopstein E. Faszia and Cartilage Palisade Tympanoplasty, Nine Years Experience. Arch Otolaryngol. 1970; 91 229-240
75 Bernal-Sprekelsen M, Barberan M T, Lliso M DR. Preliminary functional results of tympanoplasty with palisade cartilage. Acta Otorrinolaringol Esp (Spain). 1997; 48 341-346
76 Bernal-Sprekelsen M, Romaguera Lliso MD, Sanz Gonzalo JJ. Cartilage palisades in type III tympanoplasty: anatomic and functional long-term results. Otol Neurotol. 2003; 24 38-42
77 Zahnert T, Hüttenbrink K-B, Mürbe D, Bornitz M. Experimental Investigations of the use of Cartilage in Tympanic Membrane Reconstruction. Am J Otol. 2000; 21 322-328
78 Levinson R M. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope. 1987; 97 1069-1074
79 Duckert L G, Muller J, Makielski K H, Helms J. Composite autograft “shield” reconstruction of remnant tympanic membranes. Am J Otol. 1995; 16 21-26
80 Hartwein J, Leuwer R M, Kehrl W. The total reconstruction of the tympanic membrane by “crowncork” technique. Otolaryngol. 1992; 13 172-175
81 Tolsdorff P. Tympanoplastik mit Tragusknorpeltranplantat „Knorpeldeckel-Plastik”. Laryngo-Rhino-Otol. 1983; 62 97-102
82 Borkowski G, Sudhoff H, Luckhaupt H. Autologous perichondrium-cartilage graft in the treatment of total or subtotal perforations of the tympanic membrane. Laryngo-Rhino-Otol. 1999; 78 68-72
83 Rosowski J J, Merchant S (eds). The function and mechanics of normal, diseased and reconstructed middle ears. In: Rosowski JJ. Mechanism of Source Conduction in Normal Once Diseased Ear. The Hague, The Netherlands, Kugler Publications 2000
84 Wullstein H L. Operationen zur Verbesserung des Gehörs. Thieme Stuttgart; 1968
85 Bekesy G V. Experiments in hearing. (Reprint). Robert E. Krieger Publ. Comp Huntington/NY; 1960/1980
86 Stuhlmann O. The nonlinear transmission characteristics of the Auditory Ossicles. J Acoust Soc Amer. 1937; 9 119-128
87 Fischler H, Frei E H, Spira D. Dynamic response of Middle-Ear Structures. J Acoust Soc Am. 1967; 41 1220-1231
88 Gundersen T. Prostheses in the ossicular chain. 1. Mechanics of movement. Arch Otolaryngol. 1972; 96 416-425
89 Decraemer W F, Khanna S M, Funnell W R. Malleus vibration mode changes with frequency. Hear Res. 1991; 54 305-318
90 Decraemer W F, Khanna S M. Vibrations on the Malleus Measured Through the Ear Canal. In: Middle Ear Mechanics in Research and Otosurgery. Dresden; 1997: 32-39
91 Huber A. et al .Analysis of ossicular vibration in three dimensions. In: Middle ear mechanics in research and otosurgery. Dresden; 1997: 82-87
92 Zahnert T. Laser in der Ohrforschung. Laryngo-Rhino-Otol. 2003; 82 Suppl 1 157-180
93 Willi U B, Ferrazzini M A, Huber A M. The incudo-malleolar joint and sound transmission losses. Hear Res. 2002; 174 32-44
94 Decraemer W F, Khanna S M. New insights into vibration of the middle ear. In: Second International Symposium on Middle-Ear Mechanics in Research and Otosurgery. Boston, MA, USA; 1999; 2000: 23-38
95 Hüttenbrink K B. Zur funktionellen Anatomie des Mittelohrs: Die Haltebänder der Ossikelkette. Arch f Ohren-, Nasen- und Kehlkopfheilkunde. 1988; Suppl. 102-103
96 Wada H, Koike T, Kobayashi T. Three-dimensional Finite-Element Method (FEM) analysis of the human middle ear. In: Middle ear mechanics in research and otosurgery. Dresden; 1997: 76-81
97 Hudde H, Engel A. Measuring and modeling basic properties of the human middle ear and ear canal. Part I: Model structure and measuring techniques. Acustica & acta acustica. 1998; 84 720-738
98 Huber A, Linder T, Ferrazzini M, Schmid S, Dillier N, Stoeckli S, Fisch U. Intraoperative assessment of stapes movement. Ann Otol Rhinol Laryngol. 2001; 110 31-35
99 Zahnert T. Laserinterferometrische Untersuchungen zur Dynamik des gesunden, pathologisch veränderten und rekonstruierten Mittelohres. Habilitationsschrift 2003
100 Geyer G, Rocker J. Results after rebuilding the ossicular chain using the autogenous incus, ionomer-cement- and titanium-implants (tympanoplasty type III). Laryngo-Rhino-Otol. 2002; 81 164-170
101 Lang J, Kerr A G, Smyth G D. Transplanted ossicles after two decades. J Laryngol Otol. 1989; 103 471-472
102 Steinbach E. Zur Bedeutung der unveränderten Gehörknöchelchenform bei Transplantationen im menschlichen Mittelohr. Arch f Ohren-, Nasen- und Kehlkopfheilkunde. 1973; 205 146-149
103 Eitschberger E. Gefäßentwicklung in Ossikulartransplantaten und -implantaten. Laryngo-Rhino-Otol. 1980; 59 238-243.
104 Dost P. Biomaterials in reconstructive middle ear surgery. Laryngo-Rhino-Otol. 2000; 79 53-72
105 Jahnke K, Plester D. Aluminium oxide ceramic implants in middle ear surgery. Clin Otolaryngol. 1981; 6 193-195
106 Yamamoto E. Aluminum oxide ceramic ossicular replacement prosthesis. Ann Otol Rhinol Laryngol. 1985; 94 149-152
107 Jahnke K, Plester D, Heimke G. Experiences with Al2O3-ceramic middle ear implants. Biomaterials. 1983; 4 137-138
108 Reck R. 5 Jahre klinische Erfahrung mit Ceravitalprothesen im Mittelohr. HNO. 1985; 33 166-170
109 Brewis C, Orrell J, Yung M W. Ceravital revisited: lessons to be learned. Otol Neurotol. 2003; 24 20-23
110 Goldenberg R A, Emmet J R. Current use of implants in middle ear surgery. Otol Neurotol. 2001; 22 145-152
111 Grote J J, van Blitterswijk C A, Kuijpers W. Hydroxyapatite ceramic as middle ear implant material: animal experimental results. Ann Otol Rhinol Laryngol Suppl. 1986; 123 1-5
112 Costantino P D, Friedman C D, Jones K, Chow L C, Pelzer H J, Sisson G A . Hydroxyapatite cement. I. Basic chemistry and histologic properties. Arch Otolaryngol Head Neck Surg. 1991; 117 379-384
113 Gjuric M, Mladina R, Koscak J. Plastipore prosthesis in the animal experiment. Laryngo-Rhino-Otol. 1987; 66 522-525
114 Jahnke K, Dost P, Schrader M. Biocompatibility studies of implants for reconstructive middle ear surgery. In: Transplants and Implants in Otology III. Amsterdam; 1996: 41-46
115 Himi T, Igarashi M, Kataura A. Temporal bone histopathology over 15 years post-stapedectomy. Acta Otolaryngol Suppl. 1988; 447 126-134
116 Schimanski G. Erosion and necrosis of the long process of the incus after otosclerosis operation. HNO. 1997; 45 682-689
117 Heumann H, Steinbach E, Seuffer R. A clinical and experimental study on precious metal ventilation tubes. Laryngo-Rhino-Otol. 1982; 61 17-19
118 Jahnke K, Dost P, Mißfeldt N. Revisionen nach Stapeschirurgie. HNO. 1999; 47 427
119 Tange R A, Grolman W, Dreschler W A. Gold and titanium in the oval window: a comparison of two metal stapes prostheses. Otol Neurotol. 2004; 25 102-105
120 Schwager K. Epithelisierung von Titanprothesen im Mittelohr des Kaninchens. Modellvorstellungen zur Mukosaentwicklung. Laryngo-Rhino-Otol. 1998; 77 38-42
121 Schwager K, Müller J, Schön F. Verträglichkeit von Titan-Prothesen im Mittelohr - Ergebnisse einer klinischen Kontrolle. HNO. 1999; 47 430
122 Hantson P, Mathieu P, Gersdorff M, Sindic C, Lauwerys R. Encephalopathy with seizures after use of aluminium-containing bone cement. Lancet. 1994; 344 1647
123 Maassen M M, Zenner H P. Tympanoplasty Typ 2 With Ionomeric Cement and Titanium-Gold- Angle Prostheses. The American Journal of Otology. 1998; 19 693-699
124 Ozer E, Bayazit Y A, Kanlikama M, Mumbuc S, Ozen Z. Incudostapedial rebridging ossiculoplasty with bone cement. Otol Neurotol. 2002; 23 643-646
125 Zenner H P, Freitag H G, Linti C, Steinhardt U, Rodriguez J J, Preyer S, Mauz P S, Surth M, Planck H, Baumann I, Lehner R, Eiber A. Acoustomechanical properties of open TTP titanium middle ear prostheses. Hear Res. 2004; 192 36-46
126 Stupp G H, Dalchow C, Grün D, Stupp H F, Wustrow J. Titan-Prothesen im Mittelohr. 3-Jahres-Erfahrungsbericht. Laryngo-Rhino-Otol. 1999; 78 299-303
127 Hüttenbrink K B, Zahnert T, Wustenberg E G, Hofmann G. Titanium clip prosthesis. Otol Neurotol. 2004; 25 436-442
128 Dalchow C V, Grun D, Stupp H F. Reconstruction of the ossicular chain with titanium implants. Otolaryngol Head Neck Surg. 2001; 125 628-630
129 Goldenberg R A. Ossiculoplasty with composite prostheses. PORP and TORP. Otolaryngologic Clinics of North America. 1994; 27 727-745
130 Slater P W, Rizer F M, Schuring A G, Lippy W H. Practical Use of Total and Partial Ossicular Replacemet Prosthesis in Ossiculoplasty. Laryngoscope. 1997; 107 1193-1198
131 Vartiainen E, Nuutinen J. Long-Term hearing results of one-stage tympanoplasty for chronic otitis media. Eur Arch Otolaryngol. 1992; 249 329-331
132 Fisch U. Total reconstruction of the ossicular chain. Otolaryngologic Clinics of North America. 1994; 27 785-797
133 Merchant S N, Ravicz M E, Voss S E, Peake W T, Rosowski J J. Middle ear mechanics in normal, diseased and reconstructed ears. J Laryng Otol. 1998; 112 715-731
134 Goode R L, Nishihara S. Experimental models of ossiculoplasty. Otolaryngol Clin North Am. 1994; 27 663-675
135 Hüttenbrink K-B. Akustisch optimierte Mittelohrprothesen. Neue Techniken zur zukünftigen Erforschung und Entwicklung verbesserter Implantate. HNO. 1997; 7 509-511
136 Zahnert T, Schmidt R, Hüttenbrink K-B, Hardtke H-J. FE-Simulation of vibrations of the Dresden middle ear prosthesis. In: Middle ear mechanics in research and otosurgery. Dresden; 1997: 200-206
137 Meister H, Walger M, Mickenhagen A, Stennert E. Messung der Schwingungseigenschaften von Mittelohrimplantaten mit einem mechanischen Mittelohrmodell. HNO. 1998; 46 241-245
138 Meister H, Stennert E, Wolger M, Klinter H D, Mickenhagen A. Ein Meßsystem zur Überprüfung des akustomechanischen Übertragungsverhaltens von Mittelohrimplantaten. HNO. 1997; 45 81-85
139 Nishihara S, Goode R. Experimental study of the acoustic properties of incus replacement prostheses in a human temporal bone model. Am J Otol. 1994; 15 485-494
140 Schuring A G, Lippy W H. Semibiologic middle ear prostheses: ossicle cup and ossicle columella. Otolaryngol Head Neck Surg. 1982; 90 629-624
141 Eiber A, Freitag H-G, Schimanski G, Zenner H P. On the coupling of prostheses to the middle ear structure and its influence on sound transfer. In: Second International Symposium on Middle-Ear Mechanics in Research and Otosurgery. Boston, MA, USA; 1999; 2000: 297-308
142 Eiber A, Freitag H-G, Burkhardt C, Hemmert W, Maassen M M, Jorge J R, Zenner H-P. Dynamics of middle ear prostheses - simulations and measurements. Audiology & Neuro-Otology. 1999; 4 178-184
143 Morris D P, Bance M, van Wijhe R G, Kiefte M, Smith R. Optimum tension for partial ossicular replacement prosthesis reconstruction in the human middle ear. Laryngoscope. 2004; 114 305-308
144 Vlaming M S, Feenstra L. Studies on the mechanics of the reconstructed human middle ear. Clin Otolaryngol. 1986; 11 411-422
145 Koike T, Wada H, Kobayashi T, Takasaka T. Finite-element method analysis of a reconstructed middle ear. Proceedings ARO-Meeting (Association of Research in Otology) in Florida 1997
146 Koike T, Wada H, Kobayashi T. Modeling of the human middle ear using the finite-element method. The Journal of the Acoustical Society of America. 2002; 111 1306-1317
147 Asai M, Huber A, Goode R L. Analysis of the best site on the stapes footplate for ossicular chain reconstruction. Acta Otolaryngol. 1999; 119 356-361
148 Fisch U, May J. Tympanoplasty, mastoidectomy and stapes surgery. Stuttgart, New York; Thieme 1994: 39-40
149 Hüttenbrink K B, Zahnert T, Beutner D, Hofmann G. The cartilage guide: a solution for anchoring a columella-prosthesis on footplate. Laryngo-Rhino-Otol. 2004; 83 450-456
150 Huber A, Koike T, Wada H, Nandapalan V, Fisch U. Fixation of the anterior mallear ligament: Diagnosis and consequences for hearing results in stapes surgery. Ann OtoI Rhinol Laryngol. 2003; 112 348-355
151 Nakajima H H, Peake W T, Rosowski J J, Merchant S M. The Effects of Stiffening the Anterior Mallear Ligament. Singapore; World Scientific Publishing Co. Pte. Ltd 2004: 197-203
152 Koike T, Wada H, Kobayashi H. Effects of Individual Differences in Size and Stiffness of the Middle Ear on its Sound Transmission. Singapore; World Scientific Publishing Co 2004: 68-75
153 Huber A, Koike T, Wada H, Nandapalan V, Fisch U. Fixation of the anterior mallear ligament: diagnosis and consequences for hearing results in stapes surgery. Ann Otol Rhinol Laryngol. 2003; 112 348-355
154 Zou J, Bretlau P, Pyykko I, Starck J, Toppila E. Sensorineural hearing loss after vibration: an animal model for evaluating prevention and treatment of inner ear hearing loss. Acta Otolaryngol. 2001; 121 143-148
155 Shea J J. A 20-year report on fenestration of the oval window. Trans Sect Otolaryngol Am Acad Opthamol Otolaryngol. 1976; 82 ORL21-29
156 Sedwick J D, Louden C L, Shelton C. Stapedectomy vs stapedotomy. Do you really need a laser?. Arch Otolaryngol Head Neck Surg. 1997; 123 177-180
157 Fisch U, Dillier N. Technik und Spätresultate der Stapedotomie. HNO. 1987; 35 252-254
158 Häusler R. Fortschritte in der Stapeschirurgie. Laryngo-Rhino-Otol Suppl 2. 2000; 79 95-139
159 Kursten R, Schneider B, Zrunek M. Long-term results after stapedectomy versus stapedotomy. Am J Otol. 1994; 15 804-806
160 Kirikae J. The middle ear. Tokyo; The University of Tokyo Press 1960
161 Hüttenbrink K B. Biomechanics of stapesplasty: a review. Otol Neurotol. 2003; 24 548-557; discussion 557 - 549
162 Teig E, Lindemann H. Stapedotomy piston diameter - is bigger better?. Oto Rhinolaryngologia Nova. 1999; 9 252-256
163 Jovanovic S. Laser in der Otologie. Laryngo-Rhino-0tol. 2003; 82 21-53
164 Huber A M, Ma F, Felix H, Linder T. Stapes prosthesis attachment: the effect of crimping on sound transfer in otosclerosis surgery. Laryngoscope. 2003; 113 853-858

Priv.-Doz. Dr. med. Dr. h. c. Thomas Zahnert

Universitäts-HNO-Klinik Dresden

Fetscherstraße 74 · 01307 Dresden

Email: thomas.zahnert@uniklinikum-dresden.de