Experimental Fat Grafts and Teflon Pistons in Cats

IN PATIENTS with otosclerosis, stapedes have been effectively replaced by free autogenous grafts or by an absorbable gelatin sponge (Gelfoam).^1-3 Whereas these grafts protect the inner ear and function satisfactorily, stapedial operation may lead to such complications as high-frequency hearing loss with poor auditory discrimination, delayed but severe sensorineural hearing loss, formation of fistula in the oval window, and fatal meningitis.^4-6

Studies in experimental animals suggest that the rare but serious complication of delayed, severe sensorineural hearing loss may be the result of breakdown of a nonviable graft.⁷ To avert high-frequency sensorineural hearing loss after stapedectomy, Shea⁸ devised the Teflon piston operation. Tabb⁹ recently found that patients in whom stapedes were replaced by a prosthesis of Teflon wire consistently had higher levels of hearing and maintained preoperative discrimination scores more often than did those with tissue grafts. Previous histopathologic studies of free autogenous fat grafts