Heinz Kurz GmbH based in Dusslingen close to Tübingen has been supplying the world with implants for use in otorhinolaryngology for around 30 years. The success of the medium-sized company is based on the high-quality materials it uses to develop its products as well as on an intensive dialogue with the users of its products. Heinz Kurz GmbH is the European leader in middle-ear prostheses, for which it was awarded the Baden-Württemberg Innovation Prize in 2009.
Pure chance played a major part in the establishment of the company. In the 1970s, the dental technician Heinz Kurz had several friends in a group of otorhinolaryngologists headed up by Prof. Dr. Dieter Plester, the former director of the ENT Clinic at the Tübingen University Hospital (UKT). At social occasions, the subject of problems associated with the grommets (tiny tubes) that were currently available on the market would come up. Children had the biggest problems because the anatomical conditions of children’s ears often lead to middle ear infections. Grommets were often used to improve the ventilation of the middle ear, but they frequently led to intolerance and were rejected. As a specialist in the processing of gold, Kurz was asked by his doctor friends to manufacture a gold grommet.
Kurz set to work and manufactured a grommet that could be cast in gold. The gold grommet was initially tested in animals and subsequently achieved a breakthrough in humans. Using gold meant that intolerance and rejection of the grommet no longer occurred. "The success spurred my father on and gold became the material of choice for implants. Some years after the initial success, my father also started to offer gold implants for the replacement of the malleus, incus and stapes," said Traute Kurz-Butzki, daughter of the company founder and present managing director of the company that was established in 1982. Like her father, Traute Kurz-Butzki is a dental technician by training, but she then changed direction completely and started an art history and education science course. "However, I finally decided to get involved in the family company. I worked in the dental laboratory for several years, and was in charge of medical technology marketing before I became the managing director," said Kurz-Butzki.
Heinz Kurz GmbH now has a staff of 29, four of whom focus exclusively on the new and further development of implants, with support from outstanding clinical and academic partners. Dr. Albrecht Eiber from the Institute of Technical and Numerical Mechanics at the University of Stuttgart is one such partner. Eiber specialises in middle-ear mechanics and works closely with the team from Heinz Kurz GmbH in the testing of new implant materials and designs. “The middle-ear ossicles move differently when high or low sound frequencies occur. Eiber uses our prototypes to find out whether the implant fits into the mechanics,” said Kurz-Butzki.
Heinz Kurz GmbH has filed more than 50 national and international patents and has also received renowned prizes for some of its developments. The last important award the company received was the Baden-Württemberg Innovation Prize in November 2009. The prize was awarded for the development of a variable-length titanium prosthesis used for middle-ear surgery. The implant, which is marketed as TTP-VARIAC, was developed in cooperation with Prof. Dr. Hans-Peter Zenner from the Department of Otorhinolaryngology at the University Hospital of Tübingen. The length of the prosthesis can be adjusted to individual patient requirements, facilitating the work of surgeons and helping to reduce costs. The developers had to take into account the anatomical proportions in the middle ear, which differ between individuals. An implant that is able to efficiently transmit sound to the eardrum needs to bridge a gap of 1.75 to 7 millimetres. In order to be able to implant a prosthesis that fitted accurately into the middle ear, surgeons previously had to choose the best fit from among a range of prosthesis size variants.
This is now no longer necessary. The new variable prosthesis only requires two implant types to be available during surgery, a total and a partial implant. “The use of a total or partial implant depends on the type and complexity of damage. A total implant is used to replace all three ossicles. The malleus is the ossicle that is most prone to damage. Partial implants are used when the stapes is still intact, for example,” explained Kurz-Butzki. The implant is no larger than the head of a match. It consists of a titanium plant that is attached to the shaft of the implant by way of a micromechanism once the correct position and length have been determined. The surgeons can bend the shaft during surgery and adapt it to the anatomy of individual patients.
The implant is adapted to the dimensions of the middle ear using a multifunctional plastics sizer disk that is used by the surgeons to assess the length of the implant. "The sizer disk is an inexpensive disposable product, a bit like a dummy," added Kurz-Butzki. The exact length of the prosthesis is crucial for the acoustic transmission of sound. "If the prosthesis is too long, there is too much tension on the eardrum; if it is too short, the prosthesis does not come into contact with the eardrum. In addition, the length of time a prosthesis can remain in the ear depends on the accuracy of the initial fitting," said Kurz-Butzki, going on to add, "the middle ear prostheses are designed for life-long use."
The active company also has several other innovative products in its development pipeline. Kurz-Butzki cannot give any details of the company's ongoing projects due to current patent applications. However, she can tell us that the company is currently working on small innovative joints and that these microjoints are already being used in partial and stapes prostheses. Heinz Kurz GmbH achieves around 80 per cent of its revenues (~3.8 million euros per year (2009)) with ear products. "We sell thousands of grommets every year. The grommets no longer need any instructions and can easily be used by any GP. That is why we sell these tiny tubes directly to medical doctors, in particular otorhinolaryngologists in Germany." All other products, including upper lid, nose, tracheal and vocal cord implants, are sold exclusively through our distribution partners. "We train these companies' product managers in order to guarantee the best possible service for our customers," said Kurz-Butzki.