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Management of Incus Necrosis in Revision Stapedectomy Using Hydroxyapatite Bone Cement

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

doi: 10.1097/MAO.0000000000000496

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.

House Clinic, Los Angeles, California, U.S.A.

Address correspondence and reprint requests to John W. House, M.D., House Clinic, 2100 W. 3rd St., Los Angeles, CA 90057, U.S.A.; E-mail:

The authors disclose no conflicts of interest.

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