Ossicular Chain Reconstruction With Glass Ionomer Cement Following Removal of Active Middle Ear Implant

Abstract

The use of bone cement in ossicular chain reconstruction (OCR) represents an area of recent interest. This multi-institutional retrospective study assesses the efficacy of glass ionomer cement (GIC) in OCR following the explantation of a fully implantable active middle ear implant. A postoperative 4-frequency mean air-bone gap (ABG) was obtained for 15 subjects by averaging 0.5, 1, 2, and 4 kHz frequencies. For Group A (short-term, N = 15), at a mean of 4.5 months postoperatively, 9 (60%) achieved an ABG between 0 and 10 dB, 5 (33%) were 11 to 20 dB, and 1 (7%) was 21 to 30 dB. For Group B (long-term, N = 5), at a mean of 50 months postoperatively, 4 (80%) were 0 to 10 dB and 1 (20%) was 11 to 20 dB. These results suggest that GIC represents an effective means of ABG closure after device explantation.

Keywords: Esteem®; active middle ear implant; audiometry; explant; glass ionomer cement; ossiculoplasty; rebridging; reconstruction.

Figure 1

Intraoperative photographs demonstrating (A) incudostapedial discontinuity after AMEI explantation and before rebridging, and (B) reconstructed ossicular chain following ISO with GIC. AMEI, active middle ear implant; GIC, glass ionomer cement; ISO, incudostapedial ossiculoplasty.

Figure 2

Illustrations demonstrating (A) incudostapedial discontinuity after AMEI explantation and before rebridging, and (B) reconstructed ossicular chain following ISO with GIC. Created with BioRender.com. AMEI, active middle ear implant; GIC, glass ionomer cement; ISO, incudostapedial ossiculoplasty.

Figure 3

Graphical depiction of (A) Group A postoperative ABG at 0.5, 1, 2, and 4 kHz separated into 0 to 10, 11 to 20, 21 to 30, and ≥31 dB ranges, and (B) categorization of mean 4‐frequency ABG for Group A and B subjects into 0 to 10, 11 to 20, 21 to 30, and ≥31 dB. ABG, air‐bone gap.