Ossiculoplasty With Bone Cement: Audiologic Results and Cost Effective

Abstract

Background & Objective: Erosion of  incudostapedial joint (± erosion of incus long process with normal and mobile malleus) is the most injury coincidence for ossicular chain defects in chronic middle ear diseases. Bone cement is  commonly use in dentistry such as implant fixation, or in  orthopedic surgeries such as traumatic fractures. It has been used in otologic surgeries since more than two decades, especially in the ossiculoplasty . The purpose of this study is to evaluate  the audiological results of using bone cement in the reconstruction of incudostapedial joint defect, and to report the difficulties and complications resulting from its use in addition to the cost effective.

Materials and Methods : The study included 19 patients with tympanic membrane (TM) perforation and erosion of  incudostapedial joint during the period from 01/ 04 /2018 to 01/06/ 2020 , with a 6 months follow - up period post operation. Tympanoplasty was done  via post auricular approach. Bone cement was used  in cases of incudostapedial joint erosion  (±incus long process erosion). A pure tone audiogram was conducted before operation and after 6 m. Mean air-bone gap was calculated before and after the operation at the frequencies of 500-1000-2000-4000 Hz. Difficulties and complications were recorded if they occurred.

Results: Nineteen patients :12 females (63%), and 7 males (37%), with mean age 27.47 ± 9.29 years . All cases had conductive hearing loss except for one case with mixed hearing loss . The mean air bone gap (ABG) pre-operation was  36.84± 5.61  dB, and 6 m post operation was  21.05 ± 7.29 dB   with a statistically significant difference (P<0001). The mean ABG gain was 15.88±7.64 dB. The main difficulties that was encountered during surgery  was the  occurrence of some bleeding that hinders the application of bone cement until it was controlled . there was no early or late post operation infection .Cutting of the  chorda tympani was occurred  in two cases (10.5%) .

Conclusions Reconstruction of incudostapedial joint defect using bone cement  in patients with dry TM perforation is safe and simple with low cost. It maintains the physiological mechanism of ossicles, and can be an alternative to sculpted incus interposition or partial ossicular  replacement prosthesis(PORP).