Ossiculoplasty with hydroxyapatite bone cement: our reconstruction philosophy

Area of Science:

• Otolaryngology
• Biomaterials Science
• Regenerative Medicine

Background:

• Ossiculoplasty aims to reconstruct the middle ear ossicular chain to restore hearing.
• Hydroxyapatite bone cement (HABC) is a biocompatible material used in reconstructive surgery.
• Evaluating the efficacy and safety of HABC in various ossiculoplasty techniques is crucial.

Purpose of the Study:

• To analyze the anatomical and audiological outcomes of ossiculoplasties performed with hydroxyapatite bone cement (HABC).
• To compare the effectiveness of different HABC ossiculoplasty techniques for various ossicular defects.
• To assess the safety and long-term stability of HABC in ossicular reconstruction.

Main Methods:

• Retrospective case series analysis of 127 ossiculoplasties using HABC.
• Classification of procedures into three groups based on the type of ossicular defect and reconstruction method.
• Assessment of pre- and postoperative audiological results, including air-bone gap, with a mean follow-up of 26 months.

Main Results:

• Excellent hearing outcomes were achieved, with 95% of patients in Group 1 achieving an air-bone gap ≤ 20 dB.
• Group 1 (incudostapedial joint/incus long process reconstruction) showed superior results compared to partial ossicular reconstruction (Group 2) and stapes reconstruction (Group 3).
• No cement-related complications or extrusion were reported, and hearing results remained stable over time.

Conclusions:

• Ossiculoplasty with HABC is a safe, cost-effective, and user-friendly procedure yielding good and stable functional results.
• HABC facilitates the repair of diverse ossicular defects, preserving the integrity of the ossicular chain.
• Reconstruction of the incus long process or incudostapedial joint defect with HABC is the preferred method over partial ossicular reconstruction.