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Otology/Neurotology

(167) Efficacy of Bioactive Glass Obliteration for Chronically Discharging Radical Cavities

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Victor J. Kroon, MD

    PhD student
    Diakonessenhuis Utrecht, department of otolaryngology, head and neck surgery
    Utrecht, Utrecht, Netherlands

    • Co-Author(s)

  • SM

    Steven W. Mes, MD

    Senior Clinical Fellow
    Department of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust
    Cambridge, England, United Kingdom

  • PB

    Pepijn A. Borggreven, MD

    Diakonessenhuis Utrecht, department of otolaryngology, head and neck surgery, USA

  • Rv

    Rick van de Langenberg, MD

    Diakonessenhuis Utrecht, department of otolaryngology, head and neck surgery, USA

  • DC

    David R. Colnot, MD

    Diakonessenhuis Utrecht, department of otolaryngology, head and neck surgery, USA

    • Senior Author(s)

  • JQ

    Jasper J. Quak, MD

    Diakonessenhuis Utrecht, department of otolaryngology, head and neck surgery, USA

Disclosure(s):
Victor J. Kroon, MD: No relevant relationships to disclose.
Steven W. Mes, MD: No relevant relationships to disclose.


Introduction: Persistently draining radical cavities are potential sequelae of previous mastoid surgery. Some cases will remain refractory despite conservative treatment and may require revision surgery. Obliteration with bioactive glass (BAG) during revision surgery could improve outcome in terms of safe and dry ears. In this study, we present our results of secondary obliteration using BAG.

Methods: A single-center retrospective cohort study was conducted of all patients that underwent secondary obliteration of persistently draining radical cavities using S53P4 BAG between 2011 and 2022. Patients with middle ear cholesteatoma were excluded.

Results: In total, 97 patients were included with a median postoperative follow-up time of 3.9 years (IQR 2.1 – 5.9 years). The average time between initial surgery of the radical cavity and secondary obliteration was 25.3 years (SD 11.7, range 2 – 66). Postoperatively, patients were scored as either having no/minimal otorrhea (merchant grade 0-1, respectively), or frequent/persistent otorrhea (merchant grade 2-3, respectively). At the most recent follow-up visit, a merchant grade of 0-1 was observed in 95% of the cases. There were no cases of sensorineural hearing loss or facial palsy, one case developed a retro auricular skin defect and one patient developed CSF leakage. Minor complications were seen in 10 patients (10%). Ossicular chain reconstruction with a titanium prosthesis was performed in 42 cases, resulting in a median improvement of 11.2dB in air conduction thresholds. In 9/42 cases (21%), closure of the postoperative air-bone gap to ≤20 dB was achieved.

Conclusions: Revision of persistently draining radical cavities with S53P4 BAG obliteration is feasible and results in a dry and safe ear in 95% of the patients. Patients can expect major improvement with respect to discharge but the expectations of audiological gain should be modest.