title: Ossicular reconstruction: hydroxyapatite bone cement versus incus remodelling: how to manage incudostapedial discontinuity.
abstract: The objective of this study was to compare the hearing outcome using hydroxyapatite (HA) bone cement to bridge the incudostapedial gap versus incus remodelling for ossiculoplasty in case of incudostapedial discontinuity. A non-randomized retrospective study was conducted at a tertiary referral otologic centre. The intervention in 24 primary cases of conductive hearing loss was subsequent middle ear inspection where incudostapedial discontinuity was observed. HA bone cement was used in 10 consecutive cases, and incus remodelling was performed in 14 consecutive cases. Air-bone gap (ABG), bone-conduction (BC) thresholds, and air-conduction (AC) thresholds were evaluated preoperatively and at 3, 6 and 12 months postoperatively. No patients were lost to follow-up. Pure-tone averages were calculated according to the guidelines of the Committee on Hearing and Equilibrium for the evaluation of conductive hearing loss. The Amsterdam Hearing Evaluation Plots are presented. The postoperative ABG closure to within 20 and 10 dB at 12 months was, respectively, 80 and 40% in the HA bone cement group and 57.1 and 28.6% in the standard ossiculoplasty group (no statistically significant difference). However, we observed a statistically significant difference in ABG gain at 6 and 12 months favoring the HA bone cement cases. No short-term or intermediate-term adverse reactions were observed. Hydroxyapatite bone cement bridging ossiculoplasty offers a better intermediate-term ABG gain than standard ossiculoplasty. This new technique is a valuable alternative to conventional ossiculoplasty and presents the practical advantage of being easier and faster.
authors.affiliation: University Department of Otorhinolaryngology and Head and Neck Surgery, Sint Augustinus Hospital, Oosterveldlaan 24, Wilrijk, 2610 Antwerp, Belgium. thomas.somers@gza.be
authors.forename: Thomas
authors.initials: T
authors.lastname: Somers
authors.forename: Vincent
authors.initials: V
authors.lastname: Van Rompaey
authors.forename: Gerd
authors.initials: G
authors.lastname: Claes
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Salembier
authors.forename: Joost
authors.initials: J
authors.lastname: van Dinther
authors.forename: Zarowski
authors.initials: Z
authors.lastname: Andrzej
authors.forename: Erwin
authors.initials: E
authors.lastname: Offeciers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D001844:Bone Conduction; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology; D006314:Hearing Loss, Conductive / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006882:Hydroxyapatites; D007188:Incus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006882:Hydroxyapatites; C475044:hydroxyapatite cement