Physiologic reestablishment of ossicular continuity during excision of retraction pockets: use of hydroxyapatite bone cement for rebridging the incus.

OBJECTIVE: To analyze the results obtained from hydroxyapatite bone cement repair of ossicular discontinuity between the incus and stapes during surgery of retraction pockets.

DESIGN: Clinical study of a case series.

SETTING: Otolaryngology Department, Tanta University Hospitals, Tanta, Egypt.

PATIENTS: A total of 62 previously untreated patients (82 ears) with retraction pockets.

INTERVENTIONS: Hydroxyapatite bone cement was used to repair defects at the incudostapedial connection in 82 ears with retraction pockets. The ears were divided into 2 groups: group 1 included 48 ears with a small defect in the long process of the incus; group 2 included 34 ears with a large defect in the long process of the incus. In addition, 20 control patients underwent surgery using plastipore partial ossicular replacement prostheses. Hearing results were reported in 4 frequencies (0.5, 1, 2, and 3 kHz). Analysis of the results was performed using the paired t test with significance level at .05.

MAIN OUTCOME MEASURES: Anatomic and audiologic results.

RESULTS: Significant postoperative improvement of pure-tone air conduction threshold averages and air-bone gap averages were reported in the 3 studied groups. The postoperative air-bone gap averages showed significantly better outcome in groups 1 and 2 compared with controls (P<.001), while there was no statistically significant difference between groups 1 and 2 (P>.05).

CONCLUSIONS: Bone cement ossiculoplasty offers cost-effective and significant improvement in conductive hearing loss. It provides an excellent alternative to ossiculoplasty with preformed prostheses. We believe the indications for bone cement were validated by these results.