Objectives: To describe the new semisynthetic total ossicular replacement prosthesis (New-SSTORP) and to evaluate the New-SSTORP ossiculoplasty results both with the presence and absence of the stapes superstructure. Study Design: Prospective study. Setting: Tertiary referral center. Methods: From April 2023 to May 2023, 18 New-SSTORP ossiculoplasties were performed by the first author. In all patients, the New-SSTORP was interposed between the footplate and the eardrum. The study group was divided into two groups (group A and group B). Group A included 13 patients with the absence of stapes superstructure. Group B included five patients with the presence of stapes superstructure. A successful reconstruction was defined as a postoperative air-bone gap ABG ≤20 dB. For all patients of groups A and B, the last audiometric control considered was performed in January 2024. The mean follow-up was 8½ months. The χ ² test was used to compare results. p < 0.05 was considered significant. Main Outcome Measures: Mean postoperative ABG ≤20 dB Results: At the end of follow-up, the overall success rate (ABG ≤20 dB) of New-SSTORP ossiculoplasty was obtained in 88.8% (n = 16 of 18) of cases. In group A, the success rate of New-SSTORP ossiculoplasty occurred in 84.6% (n = 11 of 13) of cases, and in group B, the success rate of New-SSTORP ossiculoplasty occurred in 100% (n = 5 of 5) of cases. There was no audiological statistically significant difference between groups A and B (Fisher value is 1; p < 0.05). In all cases, the time for positioning of New-SSTORP was about 5 minutes Conclusion: The New-SSTORP has a minimal technical challenge for building and placement. The New-SSTORP ossiculoplasty results are very good both with the presence and absence of SS.

Objective: To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results. Study Design: Prospective study. Patients: The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical. Results: No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant. Conclusion: The Malafronte's stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.

Objectives: The study objective is to describe a new stapedotomy and its short-term hearing results. Study Design: Prospective study. Setting: Tertiary referral center. Methods: From February to June 2024, was conducted a study on the first 13 total columellar ossiculoplasties with footplate fenestration performed in patients with otosclerosis. In all patients, we used the new semisynthetic TORP (NSSTORP). Its base was positioned on the footplate hole rim, and its head was positioned under the eardrum. The author named this new surgical technique “tympano-stapedotomy.” For all patients, the last audiometric control considered was performed on September 2024. The mean follow-up was of 5 months. Main Outcome Measures: Percentage of patients achieving an air-bone gap (ABG) of less or equal to 10 and 20 dB. Results: At the end of follow-up, the air-conduction pure-tone average (PTA) improved from a mean of 62.1 dB (SD = 18.9) preoperatively to a mean of 42.8 dB (SD = 13.1) postoperatively: an average of 19.3 dB gain. The mean preoperative ABG was 30.9 dB (SD = 9.2), and the mean postoperative ABG was 11.6 dB (SD = 6.4): an average of 19.2 dB gain. The postoperative ABG of ≤10 was achieved in 38.5% (n = 5), of ≤15 in 77% (n = 10), and of ≤20 in 100% (n = 13). Conclusion: The NSSTORP has a minimal technical challenge for building and placement. The tympano-stapedotomy bypasses the ossicular chain and most of the challenge maneuvers and complications associated with it. Its hearing results are good.

Objective: To report the long-term hearing outcomes after ossiculoplasty using the new semi-synthetic TORP. Study design: Prospective study. Setting: Tertiary referral center. Methods: From April to May 2023, 18 ossiculoplasties using the new semi-synthetic TORP were performed by the first author. In all patients, the new semi-synthetic TORP was placed between the stapes footplate and the tympanic membrane, both in the presence and absence of the stapes superstructure. The primary outcome was the long-term postoperative air-bone gap (ABG). Hearing stability over time was assessed by comparing short- and long-term postoperative ABG. Secondary outcomes included postoperative air-conduction pure-tone average (ACPTA), word recognition scores, and the percentage of patients achieving ABG ≤20 dB. The extrusion rate was also evaluated. Results: At short-term follow-up (mean: 8.5 mo), the ABG improved from a mean of 33.5 dB (SD=8.7) to 12.2 dB (SD=5.98); 88.8% of patients (16/18) achieved ABG ≤20 dB. The short-term postoperative ABG was significantly improved compared with preoperative values (t=27.7; P <0.05). At long-term follow-up (mean 24.5 mo), the ABG improved to 13.2 dB (SD=5.49), with 83.3% of patients (15/18) achieving ABG ≤20 dB (t=15.3; P 0.05). The extrusion rate was 0%. Conclusions: The new semi-synthetic TORP ossiculoplasty demonstrated excellent and stable long-term hearing outcomes with no extrusion.

Objective: To present the initial clinical experience with tympano-stapedotomy using the new semisynthetic TORP (NSSTORP) in patients with stapes otosclerosis associated with malleus fixation and in stapedotomy revision with unusable incus, as a less invasive alternative to malleo-stapedotomy. Methods: Between June 2024 and June 2025, 6 patients (5 females, one male; mean age, 42.1 y) underwent tympano-stapedotomy at 2 tertiary referral centers: 3 primary cases with stapes otosclerosis and malleus fixation (Avellino) and 3 revision cases with incus necrosis (Siena). All procedures were performed under local anesthesia using a surgical microscope, and a 6.5-mm-long NSSTORP was implanted in every case. Pre- and postoperative audiometric evaluation included air conduction, bone conduction, and air-bone gap (ABG) at 0.5, 1, 2, and 3 kHz. The main outcome measure was postoperative ABG ≤20 dB. Follow-up ranged from 3 to 10 months (mean, 7.2 mo). Results: No patient experienced worsening of bone conduction, dizziness, or tinnitus. The pure-tone average improved from a preoperative mean of 48.9 dB (SD = 6.9) to a postoperative mean of 32.1 dB (SD = 8.4), for a mean hearing gain of 16.8 dB (SD = 4.5). The mean ABG decreased from 25.5 dB (SD = 3.8) to 11.4 dB (SD = 3.5), representing a mean improvement of 14.1 dB (SD = 3.0). A postoperative ABG of less than 20 dB was achieved in 100% of the cases. Conclusion: Tympano-stapedotomy with the NSSTORP avoids the technically demanding steps of malleo-stapedotomy and eliminates vestibular penetration.