Revision stapedectomy with bone cement: are results comparable to those of standard techniques?

OBJECTIVE

To examine hearing results in revision stapedectomy using hydroxyapatite bone cement for incus necrosis.

STUDY

DESIGN

Retrospective case series.

SETTING

Tertiary care academic medical center.

PATIENTS: Eligible patients underwent revision stapedectomy for otosclerosis using hydroxyapatite bone cement to reconstruct incus necrosis between March 2007 and August 2013. Patients were excluded for insufficient audiometric data or an operative indication other than otosclerosis.

INTERVENTION: Revision stapedectomy performed with standard stapes piston prostheses using hydroxyapatite bone cement to stabilize the prosthesis.

MAIN OUTCOME MEASURE: Air-bone gap (ABG), air-conduction and bone conduction pure-tone audiometry thresholds, and speech discrimination scores (SDSs) were obtained preoperatively and postoperatively. The preoperative result closest to the date of surgery was compared with the postoperative result farthest from the date of surgery.

RESULTS

Twenty-seven patients (aged 32-83 yr) met criteria and were included in the study. Average duration of follow-up was 7 months (range, 1-39 mo). Postoperative closure of the ABG to within 10 dB was achieved in 77.8% of cases. Closure to within 20 dB was achieved in 96.3%. The average postoperative ABG was 8.1 dB (range, 0-24 dB). The average SDS change was +7.4% (-12% to +92%). There were no cases of significant postoperative sensorineural hearing loss by bone conduction pure-tone audiometry.

CONCLUSION

Use of hydroxyapatite cement for treatment of incus necrosis in revision stapedectomy provides excellent hearing outcomes and is a reasonable alternative to total ossicular reconstruction prosthesis or malleovestibular prosthesis techniques.