Ossicular reconstruction: hydroxyapatite bone cement versus incus remodelling

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.

Résultats fonctionnels préliminaires des ossiculoplasties par ciment d’hydroxylapatite et comparaison avec les autres matériaux d’ossiculoplastie partielle

“…Ainsi, plusieurs études rétrospectives utilisant un autre type de ciment HAP ont étudié les résultats audiométriques [3,10,11], et concluent à l'amélioration des seuils auditifs.…”

“…Elsheickh et al [11] constataient des Rinne postopératoires entre 7,9 et 11,9 dB en fonction du montage réa-lisé, soit en montage direct entre bouton de l'étrier et enclume, soit après « pontage » de ces 2 structures anatomiques en cas de lyse plus importante de la branche descendante de l'enclume. De même Somers et al [10] retrouvaient des Rinne de 13,1 dB, 12,5 dB, et 12,2 dB respectivement à 3, 6 et 12 mois postopératoires.…”

“…C'est pourquoi, en alternative au ciment ionomérique, a été déve-loppé un ciment à base d'hydroxylapatite (ciment HAP), matériau ayant depuis longtemps prouvé son innocuité dans la chirurgie d'oreille moyenne. Si ce matériau semble présenter une efficacité semblable à celle du ciment ionomérique, il n'existe à ce jour qu'une étude publiée comparant le ciment HAP aux transpositions d'enclume [10] et une autre étude le comparant en prothèses partielles en hydroxylapatite [11], mais aucune étude n'a comparé systématiquement ce matériau aux autres disponibles, et notamment les prothèses en titane.…”

Evaluation on Shear Bond Strength of Different Glass Ionomer and Hydroxy Apatite Cements Used in Ossiculoplasty

“…The most important result of this (4,10,11). It is considered that the differences among the SBS values of different GICs are due to small variations in their contents.…”

“…It is now used in ear surgery for various indications, such as ossicular reconstruction, bony external ear canal repair, stabilisation of cochlear implants, repair of dural defects, and reconnecting of gaps created by incudostapedial necrosis (9). Several studies have shown that there was a considerable increase in patients' hearing quality when ossicular chain was rebuilt with GIC (4,(10)(11)(12)(13)(14). The ideal bone cement used for this purpose should be malleable, easily applied, rapidly setting, non-toxic, fluid resistant, capable of osteointegration, and able to incite minimal inflammation (1).…”