A more reliable method for incudostapedial rebridging ossiculoplasty: bone cement and wire

Polymaleinate glass ionomer cement is a commercially available bone cement (Ketac Cem Radiopaque, ESPE, Germany) that can be used to reconstruct a discontinuity between the incus and the stapes. The popularity of bone cement in otologic surgery is increasing. If the missing part of the incus is too long, the results in the long term could be unsatisfying. Under such circumstances, a new method of incudostapediopexy that uses wire and involves remodeling of the long process of the incus with bone cement is introduced. A retrospective analysis of the outcomes of incudostapedial rebridging ossiculoplasty (ISRO) procedures carried out in 21 patients between June 1999 and September 2003 was performed. A total of 17 patients were treated with bone cement only; in 4 of these patients, hearing loss reoccurred within 6 months. The procedure was repeated in 2 of these patients using both bone cement and wire with satisfactory hearing results (air-bone gaps, 7.5 and 8.8 decibels hearing level [dB HL]) after 1 year. Four patients underwent ISRO wire and bone cement initially. The long-term results of these 6 "wire-and-cement" cases, which were followed for a mean of 21 months, were satisfactory (air-bone gap, 9.8 dB HL). The postoperative air-bone gap in the 15 patients who were treated by ISRO with bone cement only excluding the 2 reoperation cases was 12.1 dB HL. ISRO with bone cement is a cost-effective and safe procedure that yields good hearing results in selected cases. If the distance between eroded incus and stapes is too long to be reconstructed with bone cement alone, the surgeon should consider using wire with bone cement.