title: Management of incus necrosis in revision stapedectomy using hydroxyapatite bone cement.
abstract: OBJECTIVE
  Review audiological outcomes after revision stapedectomy using hydroxyapatite cement.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary neurotological referral center.
  
  
  METHODS
  Thirty-seven cases of previously treated otosclerosis where incus erosion was observed during revision stapedectomy.
  
  
  METHODS
  Hydroxyapatite cement was used to rebuild the eroded incus and stabilize the prosthesis during revision stapedectomy.
  
  
  METHODS
  Pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3 kHz) including high tone BC (1, 2, 4 kHz), air-bone gap (ABG), and speech discrimination scores were measured. Short-term (3 wk) and longer-term (average 12 mo) hearing outcomes were measured. Data are reported according to the most recent guidelines of the AAO-HNS Committee on Hearing and Equilibrium.
  
  
  RESULTS
  Among 37 ears undergoing revision stapedectomy with hydroxyapatite cement, the AC PTA was 59.8 dB preoperatively and 34.6 dB postoperatively (p < 0.0001) at latest follow-up. The mean postoperative ABG was 8.8 dB (SD = 8.6, range -1.3-36.3 dB) while a mean improvement of 2.1 dB (SD = 6.5, range -8.33-15.0 dB) of the high tone BC PTA was observed. One revision case was noted during the follow-up period.
  
  
  CONCLUSIONS
  Hydroxyapatite cement is useful to reconstruct and stabilize the prosthesis in revision stapedectomy when erosion of the long process is encountered. Short- and longer-term hearing results are favorable when compared to previously reported results of revision stapedectomy.
authors.affiliation: House Clinic, Los Angeles, California, U.S.A.
authors.forename: John W
authors.initials: JW
authors.lastname: House
authors.forename: J Eric
authors.initials: JE
authors.lastname: Lupo
authors.forename: John C
authors.initials: JC
authors.lastname: Goddard
mesh_terms: D000328:Adult; D001844:Bone Conduction / Q000502:physiology; D005260:Female; D006309:Hearing / Q000502:physiology; D006320:Hearing Tests; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use*; D007188:Incus / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010040:Otosclerosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006882:Hydroxyapatites; C475044:hydroxyapatite cement