Revisiting the risks involved in using homograft ossicles in otological surgery

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.