The use of bone cement for ossicular chain defects

Abstract

Bone cement is a good and cheap option for some ossicular chain problems such as incudostapedial re-bridging. The purpose of this retrospective study is to evaluate the audiologic results after reconstruction of three different types of ossicular chain defects, using bone cement. Group 1 consists of 42 patients who underwent an ossiculoplasty using bone cement between the damaged long process of the incus and an intact stapes superstructure. Group 2 consists of 46 patients in which incus interposition between malleus and stapes superstructure was performed, using bone cement to fix the interposed incus. For group 3, consisting of 32 patients who had a present malleus, a defective long process of the incus and a missing stapes superstructure, a re-shaped incus was placed between the stapes footplate and the malleus and bone cement was again used as a fixator. Preoperative and postoperative pure-tone audiometric findings were obtained and hearing differences were assessed. The mean preoperative and postoperative air-bone gaps were 34.8 and 15.6, 35 and 18.4, and 43.4 and 19.8 for groups 1, 2, and 3, respectively. There was a significant improvement in hearing outcomes in all the groups when comparing preoperative and postoperative mean air-bone gaps (p < 0.001). The postoperative air-bone gap was ≤20 dB in 76 % of patients in group 1, 64 % of patients in group 2, and 46 % of patients in group 3. Bone cement is an effective and cheap option for some ossicular chain problems such as incudostapedial re-bridging. It may also be used to fix the interposed incus to the stapes superstructure and/or malleus to avert displacement.

The Influence of Incudostapedial Joint Separation on the Middle Ear Transfer Function

“…In cases where lenticular process has been damaged or inxus luxated appropriate reconstruction in necessary. Several possible techniques are possible including bone cement bridging, incus interposition or joint prosthesis use [15]. …”

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.…”

“…Thus, an inappropriate manipulation may cause stapes to fracture (19). The use of GICs for different ossicular reconstructions such as incus stapes re-bridging, incus augmentation, and the fixation of stapes implants have been shown by several studies as the reliable method (4,12,19,20). Baglam et al reported a significant hearing improvement after incudostapedial rebridging ossiculoplasty with KC (20).…”

“…Although replacement with a prosthesis is extensively used, this prosthesis can dislocate over time, resulting in decreasing long-term hearing quality. It was reported that, in patients requiring revision of ossiculoplasty, half of the failures result from displacement of the prosthesis (4). While the incus reposition is simple and cost effective, the prosthetic rehabilitations are time consuming and highly costing.…”

“…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).…”