Background: The cause of ossicular prosthesis extrusion remains an issue of interest to many otologists. This study evaluated the change in material surfaces and chemical elements of extruded total ossicular replacement prostheses (TORPs) and partial ossicular replacement prostheses (PORPs).

Methods: A total of nine extruded Polycel® ossicular prostheses (four TORPs, five PORPs) from nine patients was investigated using scanning electron microscope and energy dispersive X-ray spectrometry (EDX). Three prostheses (TORPs) obtained during revision surgery for hearing restoration were used as control subjects for EDX study.

Results: All subjects from the study group showed loss of fibrous capsule at both platform and shaft in the extruded prostheses. In comparison with the control group, the extruded prostheses had a lower level of carbon element (Wilcoxon signed-rank test, p < 0.05).

Conclusion: Loss of fibrous capsule and micro-degradation are probably two of the many factors that contribute to the extrusion of ossicular prostheses.

This study investigated the usefulness of three-dimensional computed tomography (3DCT) in the evaluation of bony defects caused by cholesteatoma. Fifteen patients with chronic otitis media with cholesteatoma who showed bony destruction or suspicious destruction in two-dimensional CT were examined using 3DCT. The CT data were transferred to a workstation witha real-time image processor. We used three-dimensional reconstruction software enabling image processing. In all patients, 3DCT clearly delineated the destruction of bony structures by cholesteatoma. The 3DCT-generated images provided spatial relationships, which were not easily appreciated on two-dimensional CT. Intraoperative bony destruction findings correlated with 3DCT findings. From these results, 3DCT could be useful to evaluate the invasiveness of cholesteatoma to the cranial base. It could also be helpful in planning reconstruction during surgery.

There has been a steady increase in the number of cases of methicillin-resistant Staphylococcus aureus (MRSA) otorrhoea; this is a growing concern. The purpose of this study was to evaluate the efficacy of topical vancomycin treatment in patients with MRSA otorrhoea. Fifty-five patients with MRSA otorrhoea were prospectively enrolled into the study. Thirty-five patients were treated with vancomycin eardrops as outpatients. The concentration of the locally prepared vancomycin solution was 25 mg/ml. The dose of vancomycin was two drops three times daily for 10 days. As a control group, 20 patients were treated with gentamicin 0.3% solution. Data were analysed by the Mann-Whitney U test to compare the efficacy of vancomycin eardrops and gentamicin eardrops. In the vancomycin group, the otorrhoea was significantly reduced in 33 ears (94%); in the gentamicin group, in four ears (20 per cent); this reduction was statistically significant (P < 0.03). The use of topical vancomycin treatment was effective for patients with MRSA otorrhoea refractory to conventional antibiotic treatment.