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Otology & Neurotology:
doi: 10.1097/MAO.0000000000000496

Management of Incus Necrosis in Revision Stapedectomy Using Hydroxyapatite Bone Cement

House, John W.; Lupo, J. Eric; Goddard, John C.

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Objective: Review audiological outcomes after revision stapedectomy using hydroxyapatite cement.

Study Design: Retrospective case review.

Setting: Tertiary neurotological referral center.

Patients: Thirty-seven cases of previously treated otosclerosis where incus erosion was observed during revision stapedectomy.

Intervention(s): Hydroxyapatite cement was used to rebuild the eroded incus and stabilize the prosthesis during revision stapedectomy.

Main Outcome Measure(s): Pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3 kHz) including high tone BC (1, 2, 4 kHz), air-bone gap (ABG), and speech discrimination scores were measured. Short-term (3 wk) and longer-term (average 12 mo) hearing outcomes were measured. Data are reported according to the most recent guidelines of the AAO-HNS Committee on Hearing and Equilibrium.

Results: Among 37 ears undergoing revision stapedectomy with hydroxyapatite cement, the AC PTA was 59.8 dB preoperatively and 34.6 dB postoperatively (p < 0.0001) at latest follow-up. The mean postoperative ABG was 8.8 dB (SD = 8.6, range −1.3–36.3 dB) while a mean improvement of 2.1 dB (SD = 6.5, range −8.33–15.0 dB) of the high tone BC PTA was observed. One revision case was noted during the follow-up period.

Conclusion: Hydroxyapatite cement is useful to reconstruct and stabilize the prosthesis in revision stapedectomy when erosion of the long process is encountered. Short- and longer-term hearing results are favorable when compared to previously reported results of revision stapedectomy.

Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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