Learning Objectives:

Introduction: Titianium sheeting and mesh have been used in this centre from 2008 to repair EAC defects, succeeding previous porous hydroxylapatite techniques.The purpose of this presentation was to evaluate and compare the outcomes from each material.

Materials and Method: Titanium sheeting (0.12 mm, 99% pure, annealed) was used in 111 cases, and fine mesh (Biomet) in 74. Surgical techniques were intact canal wall mastoidectomy in 130 cases, mastoidectomy reconstruction in 55. The titanium was used as a support layer, applied to the medial aspect of the bony ICW wall and overlaid with cartilage. In reconstruction cases the titanium was covered with a middle temporal flap, but with only occasional cartilage supplements.

Ossiculoplasties employed Grace Alto devices, alternatively Gyrus Spanner struts if the malleus-stapes angulation was favourable.

Results: Sheeting results were excellent for both the ICW and reconstruction roles. Mesh was disappointing. Dehiscencesof the overlying tissue occurred in 16% of 54 ICW cases, 25% of mastoid reconstructions. This was evidently due to the ittegular mesh surface causing more local reaction, but also occurred in case where wall resorption occurred after ICW. In these cases recurrent disease penetrated the mesh.

Technically, sheeting was simpler to use, as mesh snagged on the local soft tissues. At second stage surgery, sheeting was more easily cleared of fibrsosis during inspection for residual disease.

Conclusions: Titanium sheeting was highly successful in EAC defect repair, and handles better than mesh. Due to accompanying complications, mesh is no longer in use.