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Updated: Apr 25, 2026
Step-by-Step Stapedotomy through Transcanal Exclusive Endoscopic Approach
Published on: March 5, 2022
Management of incus necrosis in revision stapedectomy using hydroxyapatite bone cement
John W House1, J Eric Lupo, John C Goddard
1House Clinic, Los Angeles, California, U.S.A.
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.
