Tympano-stapedotomy With a New Semisynthetic TORP: A Less Invasive Alternative to Malleo-stapedotomy

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.