Bone Cement for Ossicular Chain Defects

Abstract Background: The discontinuity of ossicular chain most commonly affects the incudostapedial joint in 80% of patients an absent incus, or an absent incus and stapes superstructure. This discontinuity leads to a conductive hearing loss of different degrees. The goals of surgery for chronic ear disease are eradication of the disease and reconstruction of a sound transformer mechanism, but reconstructing this defect is a challenging procedure for the surgeon with different treatment options such as total ossicular chain prosthesis, a partial ossicular chain prosthesis, incus interposition, or bone cement utilization. Extrusion of the prosthesis is still a challenge in ossiculoplasty with alloplastic materials, especially in patients with poor eustachian tube function. Bone cement is cost effective, because it is cheaper than other ossiculoplasty materials, and this cost-effectiveness plays an important role in the decision the surgeon has to make, and bone cement has a promising role in this so, there is a rising interest in the otologic surgical field to use bone cement because of its biocompatible profile, its easy application, its suitable cost, and its low extrusion rate. Also, it may have a potentiality of neo-osteogenesis. Aim of Study: To evaluate the post-operative results and usefulness of bone cement application in repairing ossicular chain defects, to discuss surgical technique, and to compare pre-operative and post-operative ABG. Patients and Methods: This study was carried out in the ORL-HNS Department, Hearing and Speech Institute, from April 2015 to March 2018, on 30 patients with ossicular chain defect. Bridging of ossicular discontinuity was done by glass monomer bone cement in all patients. Results: In this study, successful hearing restoration could be achieved in 96% of the patients represented, as 52% of the patients had hearing improvement (dB gain) of more than or equal 10 dB, and 26% of patients had hearing im-provement (dB gain) more than 20 dB, and 18% of patients had hearing improvement (dB gain) of more than 40 dB, after 12 months.
Conclusion: Incudostapedial joint rebridging ossiculo-plasty with ionomeric bone cement is a reliable method for ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.