Applebaum incudostapedial prosthesis.

Erosion of the incus long process with concomitant discontinuity of the incudostapedial joint is a common cause of conductive hearing loss secondary to chronic otitis media. Treatment options for this ossicular defect include removal of the incus with incus reshaping and interposition or removal of the incus with placement of a partial ossicular prosthesis. Applebaum developed a hydroxyapatite prosthesis specifically intended to bridge this type of ossicular gap in the early 1990s. This prosthesis contains a trough that accepts the remaining incus long process remnant and a hole that accommodates the stapes capitulum. With the use of the Applebaum prosthesis to reestablish incudostapedial continuity, postoperative air-bone gaps of 20 dB or less can be achieved.

We evaluated a 16-year-old girl for a right-sided hearing loss of several years' duration. Her otologic history was significant for multiple right ear infections, which had stopped several years prior to presentation. Otoscopy revealed a normal tympanic membrane, a Weber test to the right, and a negative Rinne test at both 512 and 1,024 Hz. Audiometry revealed a conductive hearing loss, as the air-conduction pure-tone average (PTA) was 41 dB and the bone-conduction PTA was 10 dB.

The patient was taken to the operating room for middle ear exploration under local anesthesia. Intraoperative findings revealed an eroded incus long process and an intact stapes suprastructure with mobility of both the malleus-incus complex and the stapes. An Applebaum prosthesis was placed, and the ear was allowed to heal. At the 8-week follow-up, the patient's right tympanic membrane was well healed (figure). Her Rinne test was positive at 512 and 1,024 Hz, and audiometry revealed closure of the air-bone gap, as the air-conduction PTA was 21 dB and the bone-conduction PTA was 14 dB.

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Suggested reading

Applebaum EL. An hydroxylapatite prosthesis for defects of the incus long process. Laryngoscope 1993;103(3):330-2.

Schwetschenau EL, Isaacson G. Ossiculoplasty in young children with the Applebaum incudostapedial joint prosthesis. Laryngoscope 1999;109(10):1621-5.

James Lin, MD; Jose N. Fayad, MD

From the House Ear Clinic, Los Angeles.