Use of Bioactive glass S53P4 in mastoid and epitympanic obliteration: our experience in 74 cases

Abstract

Learning Objectives: Objective: to present our experience with the use of Bioactive glass S53P4 in ear surgery Material and Methods: Seventy-four cases (72 adult patients, 2 operated bilaterally) operated from May 2013 to December 2015 in a tertiary referral center. All but 10 cases were revision surgeries (mean previous operation = 2). The mean pre-operative hearing threshold was 57 ± 18 and 29 ± 15 dB for air conduction and bone conduction respectively. All patients underwent mastoid and epitympanic obliteration in a single stage CWD (n =60) or CWU (n = 14) tympanomastoidectomy. Intraoperative bacteriological test was performed for all patients. Anatomical and functional results were evaluated 3 months and 1 year after surgery, and a CT scan ±MRI was performed 1 year after surgery. Quality of life measured with the GBI and specific questionnaire was performed 1 year after surgery. Results: Cholesteatoma was found in 48 cases; Bacteriological tests showed some bacteria and/or fungus in 43 cases. At 3 months all but 2 patients had a wellhealed EAC and intact tympanic drum. Two cases of uncovered granules in the EAC underwent revision surgery for recovering of the granules with cartilage. At 1 year (n = 41), anatomical results remained stable with no cases of recurrent cholesteatoma. Regarding the hearing, one year after surgery (n = 41) the mean hearing threshold was 46 ± 22 and 27 ± 17 dB for air conduction and bone conduction respectively. CT scan (n = 41) and MRI (n = 17) showed no residual cholesteatoma inside or near the obliteration. GBI and specific questionnaire (n = 41) showed an improvement in the QOL (mean total score = 28). Conclusion: The bioactive glass S53P4 is a well-tolerated biomaterial for primary or revision chronic otitis surgery, as shown by the absence of revision surgery for removal of the granules even in case of surgery in infected ears. Hearing results depend mainly on the number of previous surgeries, and the patient's quality of life is improved after operation.