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Here, we obtained incus specimens from patients who had\u00a0cholesteatoma with\u00a0conductive hearing loss. Incudes were evaluated by micro-computed tomography, histomorphometry on undecalcified sections, quantitative backscattered electron imaging, and nanoindentation. Results were compared with two control groups taken from patients with chronic otitis media as well as from skeletally intact donors at autopsy. The porosity of incus specimens was higher in cholesteatoma than in chronic otitis media, along with a higher osteoclast surface per bone surface. Histomorphometric assessment revealed higher osteoid levels and osteocyte numbers in cholesteatoma incudes. Incudes affected by cholesteatoma also showed lower matrix mineralization compared with specimens from\u00a0healthy controls and chronic otitis media. Furthermore, the modulus-to-hardness ratio was higher in cholesteatoma specimens compared with controls. Taken together, we demonstrated increased porosity along with increased osteoclast indices, impaired matrix mineralization, and altered biomechanical properties as distinct features of the incus in cholesteatoma. Based on our findings, a possible impact of impaired bone quality on conductive hearing loss should be further explored.<\/jats:p>","DOI":"10.1007\/s00223-023-01144-6","type":"journal-article","created":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T03:18:12Z","timestamp":1698117492000},"page":"609-617","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cholesteatoma Severely Impacts the Integrity and Bone Material Quality of the Incus"],"prefix":"10.1007","volume":"113","author":[{"given":"Maximilian M.","family":"Delsmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bonik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Ocokoljic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia M.","family":"H\u00e4ussler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"P\u00fcschel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Praetorius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Amling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Peichl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1058-1307","authenticated-orcid":false,"given":"Tim","family":"Rolvien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,24]]},"reference":[{"key":"1144_CR1","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1016\/j.otc.2006.08.003","volume":"39","author":"MT Semaan","year":"2006","unstructured":"Semaan MT, Megerian CA (2006) The pathophysiology of cholesteatoma. 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Delsmann, Paul Bonik, Ana Ocokoljic, Sophia M. H\u00e4ussler, Klaus P\u00fcschel, Mark Praetorius, Michael Amling, Jonathan Peichl and Tim Rolvien state that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"Informed consent was obtained from the patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}},{"value":"The study followed the rules of the Declaration of Helsinki and was approved by the local ethics committee (Hamburg Chamber of Physicians) under WF-065\/20.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and Animal Rights"}}]}}