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Revisiting the risks involved in using homograft ossicles in otological surgery

Published online by Cambridge University Press:  12 October 2007

D Lubbe  and
J J Fagan
D Lubbe*
Affiliation:
Division of Otorhinolaryngology, Head and Neck Surgery, Groote Schuur Hospital, Cape Town, South Africa
J J Fagan
Affiliation:
Division of Otorhinolaryngology, Head and Neck Surgery, Groote Schuur Hospital, Cape Town, South Africa
*
Address for correspondence: Dr D Lubbe, Division of Otolaryngology, H53, OMB, Groote Schuur Hospital, Cape Town, South Africa 7925. Fax: +27 21 4488865 E-mail: delubbe@kingsley.co.za
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Abstract

Despite the fact that cartilage, cortical bone and corneal homograft tissue is still widely used in South Africa and that there has never been a reported case of human immunodeficiency virus or Creutzfeldt–Jakob disease infection transmission via this route, otolaryngologists are still reluctant to use homograft ossicles. In third world countries, such as South Africa, where ossicular prostheses are not always readily available due to financial constraints, the question arises as to whether we should be reconsidering the use of homograft ossicles. This review examines the risk of developing Creutzfeldt–Jakob disease or acquiring human immunodeficiency virus following the use of homograft ossicles during ossicular reconstruction, and discusses sterilization techniques that have proven effective in eradicating the human immunodeficiency virus and prions.

For decades, homograft ossicles have been used worldwide in otological surgery, especially in patients lacking suitable autograft ossicles. There has never been a reported case of transmission of the human immunodeficiency virus, and no cases of transmissible spongiform encephalopathy have been reported in the literature after otological surgery involving only the use of homograft ossicles. There have only been two documented otological cases of Creutzfeldt–Jakob disease; these involved the use of cadaveric dura mater and pericardium for tympanic membrane grafting. The human immunodeficiency virus is easily inactivated by simple sterilisation techniques, and there is a statistically insignificant risk of transmitting this virus if proper sterilisation protocols are followed.

Keywords

Homologous TransplantationCreutzfeldt-Jakob SyndromeAuditory OssiclesOtologic Surgical Procedures

Information

Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 2 , February 2008 , pp. 111 - 115
Copyright
Copyright © JLO (1984) Limited 2007

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References

1 Chalat, NI. Tympanic membrane transplant. Harper Hosp Bull 1964;22:27–34Google ScholarPubMed
2 Centers for Disease Control. Creutzfeldt-Jakob disease in a patient receiving a cadaveric dura matter graft. JAMA 1987;258:309–310CrossRefGoogle Scholar
3 Prichard, J, Thandani, V, Kalb, R, Manuelidis, E, Hadler, J. Rapidly progressive dementia in a patient who received a cadaveric dura mater graft. Morbidity and Mortality Weekly Report 1987;34:49–55Google Scholar
4 Government News Network. http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=254733&NewsAreaID=2&NavigatedFromDepartment=False [16 September 2007]Google Scholar
5 Anonymous. Round Table Discussion, Over Creutzfeldt-Jacob disease. J Jpn Med Assoc 1997;117:2015Google Scholar
6 Tange, RA, Troost, D, Limburg, M. Progressive fatal dementia in a patient who received homograft tissue for tympanic membrane closure. Eur Arch Otorhinolaryngol 1990;247:199–201CrossRefGoogle Scholar
7 Bingham, B. New variant CJD-BSE: the need for disposable ENT instruments. Int J Pediatr Otorhinolaryngol 2002;62:203–6CrossRefGoogle ScholarPubMed
8 Mehanna, H, Rejali, D, Murray, A. Suspending tonsillectomy: the effects on primary and secondary acute care in Scotland. Scott Med J 2004;49:144–5CrossRefGoogle ScholarPubMed
9 European Group on Ethics in Science and New Technologies. http://ec.europa.eu/european_group_ethics/docs/avis11_en.pdf [16 September 2007]Google Scholar
10 Bauer, M. Ossiculoplasty: autogenous bone grafts, 34 years experience. Clin Otolarynogol 2000;25:257–63CrossRefGoogle ScholarPubMed
11 Doerr, HW, Cinatl, J, Stürmer, M, Rabenau, HF. Prions and orthopedic surgery. Infection 2003;3:163–70CrossRefGoogle Scholar
12 The National Prion Disease Pathology Surveillance Center. http://www.cjdsurveillance.com [16 September 2007]Google Scholar
13 Minatogawa, T, Kumoi, T. Problems in utility and safety of otological allografts. Transplant Proc 1999;31:2036–7CrossRefGoogle ScholarPubMed
14 Lang, CJG, Heckmann, G, Neundorfer, B. Creutzfeldt-Jakob disease via dural and corneal transplants. J Neurol Sci 1998;160:112–39CrossRefGoogle ScholarPubMed
15 Anonymous. Update: Creutzfeldt-Jakob disease associated with cadaveric dura mater grafts – Japan 1979–2003. Morbidity and Mortality Weekly Report 2003;52:1179–81Google Scholar
16 Toovey, S, Britz, M, Hewlett, R. A case of dura mater graft-associated Creutzfeldt-Jakob disease in South Africa. S Afr Med J 2006;96:7Google ScholarPubMed
17 Nunery, WR. Risk of prion transmission with the use of xenografts and allografts in surgery. Ophthal Plast Reconstr Surg 2001;17:389–94CrossRefGoogle ScholarPubMed
18 Dormont, D. How to limit the spread of Creutzfeldt-Jakob disease. Infect Control Hosp Epidemiol 1996;17:521–8CrossRefGoogle ScholarPubMed
19 Doerr, HW, Cinatl, J, Stürmer, M, Rabenau, HF. Prions and orthopedic surgery. Infection 2003;31:167–8CrossRefGoogle ScholarPubMed
20 The Times, Sept 27 2004. http://www.timesonline.co.uk/tol/news/uk/health/article466397.ece [12 July 2007]Google Scholar
21 Taylor, DM. Inactivation of the unconventional agents of scrapie, bovine spongiform encephalopathy and Creutzfeldt-Jakob disease. J Hops Infect 1991; 18(Suppl A): 141–6. In Russel, AD, Hugo, WB, Ayliffe, GAJ, eds. Principles and Practice of Disinfection, Preservation and Sterilization. London: Blackwell, 1999;222–36Google Scholar
22 Dickinson, AG, Taylor, DM. Resistance of scrapie agent to decontamination [Letter]. N Engl J Med 1978;229:1413–4; Taylor DM. Resistance of transmissible spongiform encephalopathy agents to decontamination. In: Rabenau HF, Cinatl J, Doerr HW, eds. Prions – a Challenge for Science, Medicine and Public Health System. Contrib Microbiol. Basel: Karger, 2001;7:58–67Google Scholar
23 Taylor, DM. Inactivation of transmissible degenerative encephalopathy agents: a review. Vet J 2000;159:10–17CrossRefGoogle ScholarPubMed
24 Hotz, MA, Speirs, AD, Oxland, T, Müller, M, Hämmerle, C, Häusler, R. Radiologic and mechanical properties of inactivated ossicle homografts. Laryngoscope 1999;109:65–9CrossRefGoogle ScholarPubMed
25 Romualdeza, JA, Staufferb, E, Häusler, R, Hotz, MA. A new ossicle homograft inactivation/preservation procedure: clinical results. ORL J Otorinolaryngol Relat Spec 2005;67:34–8CrossRefGoogle Scholar
26 Meylan, PR, Duscher, A, Mudry, A, Monnier, P. Risk of transmission of HIV infection during tympano-ossicular homograft: an experimental study. Laryngoscope 1996;106:334–7CrossRefGoogle ScholarPubMed
27 Miman, MC, Cura, O, Erdem, T, Kirazli, T, Oztop, F, Ozturan, O et al. An important procedure in ossiculoplasty: autoclaving the ossicles. Rev Laryngol Otol Rhinol (Bord) 2002;123:263–6Google ScholarPubMed
28 Lindeque, BPG, Lindeque, AM, Hausner, H, Le Roux, TLB. Tissue banking in South Africa: a 19-year history. Cell And Tissue Banking 2005;6:65–70CrossRefGoogle ScholarPubMed
29 Romanet, P, Duvillard, C, Delouane, M. Mastoid cortical bone grafts in ossiculoplasty. Ann Otolaryngol Chir Cervicofac 2000;117:105–9Google ScholarPubMed
30 McGee, M, Hough, JV. Ossiculoplasty. Otolaryngol Clin North Am 1999;32:471–88CrossRefGoogle ScholarPubMed
31 Hotz, MA, Häusler, RH. Ossicle homografts revisited. Laryngoscope 2003;113:1274–5Google ScholarPubMed
32 WHO infection control guidelines for transmissible spongiform encephalopathies; 1999 http://www.who.int/csr/resources/publications/bse/whocdscsraph2003.pdf [23 July 2007]Google Scholar