European Counterpoint to Chapter 17

Abstract

The principles of reparative and reconstructive microsurgery on the middle ear are identical throughout the world. The first step in chronic middle ear disease is control of the disease process. The second step is restoration of middle ear function, either immediately or after approximately 1 year, depending on the intraoperative findings. Substantial regional variation is observed as to the choice of materials employed for implantation. Thus, synthetic materials that are preferred in many Anglo-Saxon countries (including the primary authors of this chapter) have failed to become popular in Germany. In German-speaking countries, the use of synthetic materials is restricted to placement of platinum ribbon Teflon prostheses in otosclerotic surgery. Despite its biocompatibility and stability after implantation, dense hydroxyapatite has not gained acceptance because of the virtually simultaneous development of ionomeric cement implants and the advent of the currently popular titanium ossicles.