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Mastoid obliteration with hydroxyapatite vs. bone pâté in mastoidectomy surgery performed on patients with cholesteatoma and chronic suppurative otitis media: a retrospective analysis

  • Otology
  • Published:
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Abstract

Purpose

To compare the efficacy and safety of hydroxyapatite vs. bone pâté as obliteration material in mastoidectomy surgery for patients with chronic suppurative otitis media and cholesteatoma.

Methods

This is a retrospective, multi-center, cohort study. All patients were followed up with micro-otoscopy, audiometry, and, if indicated, MRI with diffusion-weighted imaging. The following outcome parameters were analyzed: procedure safety (wound infections and complications), cholesteatoma recidivism rates (residual/recurrent), control of infection (Merchant’s scale), and hearing results (pure-tone averages at 500/1000/2000/4000 Hz).

Results

Eighty-three cases were included: 45 obliterated with hydroxyapatite and 38 with bone pâté, with a mean follow-up time of, respectively, 25 and 24 months. Wound infections were only detected in the bone pâté group (4.8%) and successfully treated with oral or intravenous antibiotics and surgical drainage (p = 0.026). No other major surgical complications were observed in both groups. Cholesteatoma recidivism was observed in 15% using hydroxyapatite and 12% using bone pâté (p = 0.471). Complete control of infection (Merchant 0) was achieved in 76.2% using bone pâté and 86.8% using hydroxyapatite at 12 months postoperatively (p = 0.223). All patients showed good postoperative healing without complete failure to manage infection (Merchant 3). Pre- and postoperative audiometry showed significant improvement in hearing results in both groups. No significant difference between the obliteration materials was observed.

Conclusions

Evaluation of mastoid obliteration reveals that hydroxyapatite and bone pâté are safe and effective obliteration materials, with high success rates in achieving a dry ear, low recidivism rates, and good hearing outcome, respecting the short-term limitation. In addition, our study shows that hydroxyapatite results in fewer postoperative wound infections compared to bone pâté.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ, Enschede, Netherlands

    Jantine J. Lindeboom, B. O. Westerlaken, D. A. van Zuijlen & F. B. van der Beek

  2. Department of Otorhinolaryngology, Deventer Hospital, Deventer, Netherlands

    Jantine J. Lindeboom, P. M. W. van Kempen, J. Buwalda & S. J. H. Bom

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  1. Jantine J. Lindeboom
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  2. P. M. W. van Kempen
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  3. J. Buwalda
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  4. B. O. Westerlaken
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Contributions

All authors made substantial contributions to the study conception and design. The first draft of the manuscript was written by JJL and all authors revised it critically multiple times. All authors read and approved the final manuscript.

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Correspondence to Jantine J. Lindeboom.

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Lindeboom, J.J., van Kempen, P.M.W., Buwalda, J. et al. Mastoid obliteration with hydroxyapatite vs. bone pâté in mastoidectomy surgery performed on patients with cholesteatoma and chronic suppurative otitis media: a retrospective analysis. Eur Arch Otorhinolaryngol 280, 1703–1711 (2023). https://doi.org/10.1007/s00405-022-07661-8

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