Management of Incus Defects in Children: Comparison of Incus Transposition Versus Glass Ionomer Cement

Abstract

The aim of this study was to investigate the functional results of glass ionomer cement (GIC) and incus transposition (IT) used for treatment of incus long process defects in pediatric patients. The medical records of 40 patients, aged 10 to 16 years, who underwent ossicular reconstruction due to incus long process defect between January 2010 and July 2017 were reviewed for age and gender, types of ossiculoplasty technique, types of graft used for tympanic membrane repair, preoperative-postoperative audiological examinations, and length of follow-up. The mean preoperative air-bone gap (ABG) was 29.40 (8.47) dB, the mean postoperative ABG was 15.25 (8.55) dB in the entire group, and the difference was statistically significant (P < .001). The functional outcome (ABG 20 dB) was 80% (32 patients) in the entire group. The mean hearing gain was 18.83 (9.43) dB and postoperative mean ABG was 20 dB or better in 17 (94.4%) patients in the GIC group. The mean hearing gain was 10.31 (9.44) dB, and postoperative mean ABG was 20 dB or better in 14 (63.6%) patients in the IT group. The mean hearing gain was significantly higher in the GIC group than in the IT group (P ¼ .026), and the postoperative mean ABG was significantly higher in the IT group than in the GIC group (P ¼ .045). The functional success rates were significantly higher in GIC group than in IT group (P ¼ .020). There were no statistically significant differences between groups in terms of postoperative speech reception threshold and word recognition scores (P ¼ .628, P ¼ .260, respectively). The graft success rates were 94.4% (17 patients) in the GIC group and 90.9% (20 patients) in the IT groups. There was no statistically significant difference between groups in operated side (P ¼ 1.000). Reconstruction of small incus long process defects using GIC is a valuable technique and can be safely used in pediatric patients. The hearing outcomes are significantly better in GIC rebridging technique when compared with a sculpted IT technique.

Endoscopic transcanal management of incus long process defects: rebridging with bone cement versus incus interposition

“…They are generally divided into autografts, homografts and allografts [ 15 ]. The use of homografts is abandoned in many countries due to the risk of transmission of infectious diseases [ 6 ]. Ossicles, cortical bone, and cartilage may be utilized as autografts.…”

“…They have the advantages of biocompatibility, low extrusion rate, cost-effectiveness (as they are readily available in surgical field) and absence of risk of transmission of infection. Their disadvantages, on the other hand, include necrosis, adhesion and displacement [ 6 , 15 ]. Allografts are made from synesthetic biocompatible materials (e.g., Teflon, ceramics, porus plastics, titanium, gold…etc.).…”

Chronische mesotympanale Otitis media – Teil 2: operative Therapie

“…In einer Studie an 40 Patienten und einer Nachbeobachtungszeit von 4 Jahren reduzierte sich der ABG von 27,65 dB auf 19,65 dB und liegt damit in der Größenordnung der Winkelprothese [24]. Bei Kindern wurde das Re-Bridging mit der Interposition verglichen, wobei der Hörgewinn in der Ionomerzementgruppe signifikant besser war als nach Interposition des Ambosses [25]. In einer prospektiven, randomisierten Studie wurden 30 Patienten mit TORP-Rekonstruktion nach Radikalhöhlenanlage mit Cartilage-Shoe (Gruppe 1) mit 30 Patienten und klassischer TORP-Rekonstruktion (Gruppe 2) verglichen [31].…”