Glass ionomer cement in incudostapedial rebridging ossiculoplasty: A systematic review and meta-analysis

To evaluate the hearing outcomes and surgical success of glass ionomer cement (GIC) in incudostapedial rebridging ossiculoplasty (ISRO) in patients with different middle ear pathologies.

A systematic literature review was conducted on Medline (via PubMed), the Cochrane Database, and Scopus from database inception to July 4, 2025. Two independent authors reviewed selected studies assessing the short-, middle-, or long-term tone audiometry results, the air-bone gap (ABG) closure percentage, and cement failure outcomes. The review adhered to the PRISMA reporting standards. Meta-analysis calculated the mean differences between post- and pre-operative pure-tone audiometry values (pooled estimates and 95% confidence intervals). ABG closure was analyzed with a meta-analysis of proportions applying a logit transformation.

Twenty-four studies (17 observational cohort and 8 observational case-series) were included in this review, encompassing 749 patients receiving ISRO. All studies included provided preoperative and postoperative hearing outcomes. Nineteen studies reported outcomes regarding ABG closure < 20 dB, 10 regarding closure < 10 dB, 7 regarding cement failure, and 8 regarding postoperative adverse events following ISRO. A pooled mean change in ABG values of - 16.54 dB (95% CI - 20.61 to - 12.47) and in air conduction values of - 18.01 dB (95% CI - 20.86 to - 15.17) was achieved from pre- to post-operative middle-term outcomes. The pooled success rate was 77.3% for ABG < 20 dB (95% CI 71.9-82.0), and 52.7% (95% CI 41.3-63.8) for ABG < 10 dB.

Incudostapedial rebridging ossiculoplasty (ISRO) appears to be a reliable solution with good hearing outcomes 1 to 3 years postoperatively.