How effective is bone cement on mean post-operative air-bone gap (ABG) in patients undergoing ossicular chain reconstruction or revision stapes surgery?
Background: Erosion of the long process of the incus is the most common ossicular chain pathology, due to otitis media. A successful ossiculoplasty reestablishes the connection between the tympanic membrane and the inner ear, restoring conductive hearing loss; however, no single technique for the connection has received universal acceptance. In recent years, bone cements, which were originally used in dental surgery, have also become popular in ossiculoplasty.
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January 2015Study design: Systematic literature search and review of 12 studies.
Setting: PubMed, Embase, and CENTRAL databases.
Synopsis: Major dissimilarities in study designs regarding the indication for surgery, the type of bone cement that was used, and the follow-up duration prohibited authors from pooling data. Three out of 11 studies reported statistically significant risk differences (RD) in the percentage of patients with ABG closure to within 20 dB; the results of all three favored bone cement use. Three out of 11 studies showed a statistically significant mean difference in ABG closure in favor of bone cement. However, several studies that reported a significant RD in ABG closure to within 20 dB in favor of bone cement did not report a difference in mean ABG closure between the two groups, and vice versa. No case series (>10 cases) were available on the long-term stability of bone cement in ossicular chain reconstruction or revision stapes surgery. Only one study showed a difference for both outcome measures in favor of bone cement. The other studies did not show a (statistically significant) difference in ABG closure to within 20 dB or mean ABG closure between the use of bone cement and various conventional rebridging techniques. Limitations included a moderate bias risk due to a lack of randomization, concealed allocation, blinding of observations, poorly standardized treatment and test procedures, and incomplete data.
Bottom line: There is no sufficient evidence to support superiority of bone cement compared with conventional techniques, as current studies reporting the effect of bone cement in ossiculoplasty and revision stapes surgery are at considerable risk of bias.
Reviewed by Amy E. Hamaker