Systematic review of the use of bone cement in ossicular chain reconstruction and revision stapes surgery

Abstract

Objectives/hypothesis: To evaluate the effectiveness of bone cement on mean postoperative air-bone gap (ABG) and the proportion of ABG closure to within 20 dB in patients undergoing ossicular chain reconstruction or revision stapes surgery.

Data sources: PubMed, Embase, and Central.

Methods: A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Mean differences, risk differences, and their 95% confidence intervals were extracted for the outcomes of interest.

Results: Twelve studies with high relevance and moderate RoB were included for data extraction. Seven of these were two-armed studies, and five were one-armed studies. ABG closure to within 20 dB was assessed in 11 studies and achieved in 60% to 94% of patients who were treated with bone cement. Mean ABG closure ranged from 15 dB to 23 dB in patients treated with bone cement across 11 studies. Most of the two-armed studies did not show a statistically significant difference between the use of bone cement and various conventional rebridging techniques, including allograft or autograft interposition and partial ossicular replacement prosthesis.

Conclusion: There is no sufficient evidence to support superiority of use of bone cement compared to conventional techniques. It seems from the available evidence that bone cement does not underachieve in ossiculoplasty compared to conventional rebridging techniques.

Keywords: Ossiculoplasty; bone cement; glass ionomer; hydroxyapatite; ossicular chain reconstruction; revision stapes surgery.