Hydroxyapatite Prostheses in Endoscopic Transcanal Stapes Surgery for Otosclerosis Cases

Abstract

Objectives: Hydroxyapatite is a commonly used material for medical applications due to its excellent biocompatibility. We use hydroxyapatite prosthesis for the reconstruction of the ossicular chain in stapes surgery. In this study, we report a case series of endoscopic ear surgery using a basket-type hydroxyapatite prosthesis. Methods: We retrospectively examined 8 cases of endoscopic transcanal stapes surgery using hydroxyapatite prostheses. We evaluated the postoperative results and complications. Results: The average postoperative air–bone gaps were within 10 dB in all cases. Postoperative sensorineural hearing loss was not observed in any case. There was an intraoperative complication with the chorda tympani in 1 patient. We were able to preserve the chorda tympani of all patients, including this case. Postoperative transient dizziness and transient taste disorder were observed in 50% of cases. No other complications, including facial nerve palsy, tympanic membrane perforation, or postoperative infection, were observed. Conclusions: The postoperative results and complications were comparable to those of surgery under a microscope. The hydroxyapatite prosthesis could be a possible alternative for the piston-type titanium or polytetrafluoroethylene prosthesis.

Outcomes of Endoscopic Stapedectomy: Systematic Review

“…Postoperative complications after stapes surgery vary from sensorineural hearing loss (SNHL) and dizziness to dysgeusia due to injury to the chorda tympani. Postoperative 10 reported the highest rate, of 66.67%, followed by Hosoya et al 17 (50%), while Gulsen and Karatas 14 reported the lowest rate: 2.63%. Dursun et al 9 and Naik and Nemade 16 did not report cases of postoperative dizziness.…”

“…Regarding transient postoperative dizziness, the overall rate was of 8.4% (range: 2.63% to 66.67%) cases. Marchioni et al 10 reported the highest rate, of 66.67%, followed by Hosoya et al 17 (50%), while Gulsen and Karatas 14 reported the lowest rate: 2.63%. Dursun et al 9 and Naik and Nemade 16 did not report cases of postoperative dizziness.…”

“…Marchioni et al 10 only included stapes malformation, which explains the high rate of complications observed in their study. But the other articles 2 7 8 9 10 11 12 13 14 15 16 17 reported far less complications in ears with normal anatomy.…”

“…The tip of the endoscope induces thermal injury to the inner ear; this is the main explanation for the postoperative dizziness and hearing affection observed in certain studies. 2,9,10,[13][14][15][16][17] Dysgeusia following stapes surgery can occur even with preservation of the chorda tympani, and the overall rate in the present systematic review was of 6.5% Marchioni et al 10 reported the highest rate (4 out of 6 cases), followed by Hosoya et al 17 There were no recorded cases in the studies by Daneshi and Jahandideh, 7 Ianella and Magliulo, 8 Naik and Nemade, 16 Bhardwaj et al, 12 and Plodpai et al 2 Monier et al 13 and Bianconi et al 15 found only one case each, and the ratesin the studies by Dursun et al 9 and Gulsen and Karatas 14 were of 16.13% and 18.42% respectively. Marchioni et al 10 only included stapes malformation, which explains the high rate of complications observed in their study.…”

“…The tip of the endoscope induces thermal injury to the inner ear; this is the main explanation for the postoperative dizziness and hearing affection observed in certain studies. 2 9 10 13 14 15 16 17 …”