Can homograft ossicles still be used in ossiculoplasty?

The use of ossicular homografts has been legally forbidden in many countries for the last five years. In Turkey, imported ossicular biomaterials are very expensive. Malleus and incus homografts were mostly obtained during non-functional ear microsurgery on selected patients using a detailed history and special preoperative tests to avoid the risk of virus contamination. In order to determine the method for the procedure, the ossicles were first investigated histologically. The histological studies have shown, that there are no differences in the organic osseus matrix, the collagen fibres and the lamellar structure formed by these fibres in all groups of ossicles. According to the classical method, we preferred autoclaving at 135 degrees C temperature for 20 minutes after immersing the ossicles in 4% formol solution at pH 5.6 for 3 days. These ossicles were kept in 0.5% formol solution at pH 7 refrigerated at 4 degrees C. Until 1995, allograft ossicles, treated with formaldehyde solution without sterilization in the autoclave were our choice. For the last 4 years, we have been using sterilization with the autoclave especially to inactivate the prions. If the ossicles of the patient are over-eroded, ossicular allografts, which can be obtained without any cost are still a choice of treatment in our country. In the surgery of cholesteatomacous chronic otitis media, the malleus and incus which were in contact with the cholesteatoma, could be used like an autograft in ossiculoplasties, after autoclaving.