Usefulness of hydroxyapatite bone cement to overcome crimping problems in primary stapedotomyUsefulness of hydroxyapatite bone cement to overcome crimping problems in primary stapedotomy
Faculty of Medicine and Health Sciences
Journal of International Advanced Otology
7(2011):2, p. 165-171
University of Antwerp
Objective: To report hearing outcome in primary stapedotomy cases where crimping is difficult and hydroxyapatite (HA) bone cement is used to fix the prosthesis around the long process of the incus. Study design: Nonrandomised, retrospective cohort study. Setting: One tertiary-referral otologic center. Materials and Methods: Twenty-three primary cases of surgically treated otosclerosis where an unsatisfactory crimp was obtained and HA bone cement was used to secure the prosthesis. Air-bone gap (ABG), bone-conduction (BC) and airconduction thresholds were evaluated preoperatively, at 1-3 months and last follow-up available. Pure-tone averages were calculated according to the guidelines of the Committee on Hearing and Equilibrium for evaluating conductive hearing loss. Results: Nine male patients and 14 female patients were included. Age varied from 39 years to 79 years (median 53 years). Median short-term follow-up was 2.5 months. Median intermediate-term follow-up was 12 months (at last follow-up available). At short-term and intermediate-term, the respective median postoperative ABG was 11.9 dB and 10.6 dB in the study group. No adverse reactions or unsuspected BC deteriorations were seen. Conclusion: In surgically treated otosclerosis patients where unsatisfactory prosthesis crimping is experienced, the additional fixation of the piston using HA bone cement can provide a clinically significant hearing improvement by avoiding a loose-piston syndrome. However, it does not provide a similar improvement when compared to patients where the crimping act is performed without difficulties.