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PubMed1999

Tympanoplasty: prudent considerations of silent otitis media and interactions of middle ear and inner ear.

Otitis media is a common problem, often with simple, minimally invasive solutions; however, a small subset of patients progress to chronic disease despite provision of standard therapies. The flexible approach to tympanoplasty is a prudent consideration for patients with chronic otitis media, especially children. This article discusses the findings and implications of silent otitis media, interactions of the middle ear and inner ear, and obstructive sites in the middle ear cleft. Tympanoplasty by the flexible approach is described in the context of these findings.

Acute Disease↗
PubMedDate not supplied

Iatrogenic incudostapedial joint dislocation in transcanal tympanoplasty.

PURPOSE: To report the result of transcanal tympanoplasty using Lyodura as a graft. MATERIALS AND METHODS: One hundred thirty-seven patients with chronic suppurative otitis media with a dry perforation were considered for tympanoplasty. The transcanal permeatal approach was adopted. Lyodura as a ready-made graft was used. RESULTS: The success rate of the graft was 78%. Latrogenic incudostapedial joint dislocation was found in six patients (4.4%), and sensorineural hearing loss occurred in nine patients (6.5%). CONCLUSION: The use of thick dura as a graft for repair of the tympanic membrane may result in damage to the ossicular chain or dislocation of the incudostapedial joint when used as underlay. Excessive manipulation of the ossicles or drilling should be avoided.

Adolescent↗
PubMed1999

Tympanoplasty in a patient with hemophilia B.

We report the case of a 36-year-old hemophilia B who suffered from cholesteatoma and underwent tympanoplasty. Though the factor IX activity was less than 1% of normal before surgery, adequate replacement of factor IX led to the achievement of hemostasis during and after surgery. The cholesteatoma was completely extirpated with matrix, and a type I canal-up tympanoplasty was subsequently performed. Careful preoperative evaluation and close cooperation with the hematologist are required if surgery is to be successful. We also present here the use of continuous administration of monoclonal antibody-purified factor IX concentrate, Christmassin M.

Adult↗
PubMedDate not supplied

Tympanoplasty: surgical results and a comparison of the factors that may interfere in their success.

UNLABELLED: Chronic otitis media has a high prevalence on the population and their treatment continuous to be a challenge for the otorhinolaryngologists. AIM: To demonstrate the factors that could interfere in the tympanoplasty success and the surgical results during 2002. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: were included 37 patients with chronic otitis media non cholesteatoma (COMNC) undergo to tympanoplasty (in lay or underlay, with homologous graft). All the patients were submitted to a survey pre and postoperative include clinical, physical examinations, flexible nasal endoscope and audiometry. RESULTS: The age, the dimension and localization of the tympanic membrane perforation; the condition of middle ear mucosa; number of otorrhea/year; smoking; parents history of otorrhea and hearing loss; personals history of otological surgery; monthly family income; the graft, technique and access used were not significantly to repair tympanic membrane perforations. The closure rate was 65% and the gain in air-bone gap was 100%. CONCLUSION: The timpanoplasty must be considerate in the treatment of the COMNC.

Adolescent↗
PubMed1999

Paediatric tympanoplasty.

Much debate exists over the management of mucosal chronic suppurative otitis media in children, with the majority of it centred around the correct timing to perform either a myringoplasty (an operative repair of the tympanic membrane) or type I tympanoplasty (reconstruction of the tympanic membrane when there is an intact and mobile ossicular chain). Further discussion will use the term tympanoplasty to mean both of the above definitions. We present the findings of a recent survey of UK ENT consultants questioning their opinions on various management aspects of mucosal CSOM in the paediatric population. We also present an extensive review of the literature to provide us with published evidence in order to analyse the results of the questionnaire.

Adolescent↗
PubMed1997

Management of acquired cholesteatoma of the middle ear and the mastoid by combined approach tympanoplasty: a long-term view.

Mastoid cavities following surgery for cholesteatoma of the middle ear and the mastoid can be subject to recurrent infections, life-long attendance for cavity cleaning and restrictions in social activity. These problems may be avoided with a successful combined approach tympanoplasty. One hundred and forty-one patients (151 ears) treated by combined approach tympanoplasty, followed over a period ranging from 5 to 23 yr were analysed. The results are presented with an average follow-up of 14.5 yr. A fixed retraction pocket, recurrent cholesteatoma or conversion to a cavity was regarded as a failure. Failures and evidence of future failures in the form of fixed retraction pockets occurred in the first 5 yr. By not including cases with a follow-up period of less than 5 yr, we have attempted to achieve stable long-term results; 73.5% of the cases were successful. The success rate could be improved further and should provide an acceptable method of treatment.

Adolescent↗
PubMedDate not supplied

AlloDerm tympanoplasty of tympanic membrane perforations.

PURPOSE: To study the effectiveness of AlloDerm (LifeCell Corporation, Branchburg, NJ) as a graft material in underlay tympanoplasty by comparison to autologous fascia in a chronic tympanic membrane perforation animal model. MATERIALS AND METHODS: Seventeen chinchillas underwent creation of bilateral chronic tympanic membrane perforations over a 6-week period. Twenty-two stable perforations were divided equally between the experimental AlloDerm and control fascia graft groups. The grafts were surgically placed through a postauricular tympanomeatal flap. The tympanic membranes were examined at 4 and 10 weeks and then harvested for histopathological analysis. Tympanoplasty operative times, perforation closure rates, and gross and histological analyses were compared between the AlloDerm and fascia grafts. RESULTS: A statistically significant difference in mean surgical time was recorded between the AlloDerm (47 minutes) and fascia (68 minutes) grafting procedures (t test, P =.001). Perforation closure was achieved in 90% of the AlloDerm and 100% of the fascia treated tympanic membranes. Gross and histopathologic inspections revealed no significant differences. Microscopically, AlloDerm and fascia grafts had similar inflammatory responses, but AlloDerm showed increased fibroblast infiltration and neovascularization. CONCLUSION: The avoidance of donor site morbidity, reduction of surgical time, and excellent gross and histologic outcomes in this animal model reveal that AlloDerm could be a safe, cost-effective alternative to autologous fascia. Further study would be necessary in human clinical trials.

Animals↗
PubMed2000

Reasons for reperforation after tympanoplasty in children.

In 116 children and 124 ears with non-cholesteatomatous chronic otitis media operated on during a 13-year period from 1968 to 1980 via transcanal tympanoplasty and followed with several re-evaluations 15-27 years after operation, the causes of reperforation have been analysed. In total, 14 ears (11%) had reperformation; in 7 ears (5.6%), the reperforations occurred early (during the first 3 months) and in 7 ears late (after 6 months), but most often the reperforations occurred after 10 years. The early reperforations were presumably failures in surgery. Less experienced surgeons and inflamed, wet middle ear mucosa during the primary surgery seemed to be the two most important causal factors. Young age at surgery, size and site of the perforation and Eustachian tube function seemed to be of no importance for reperforation. The early reperforations were closed at surgery and remained closed into adulthood. The reasons for late reperforations are less clear; they were presumably caused by acute otitis media with perforation in an atrophic part of the drum, which did not heal. The reperforations were small, but it was possible to close all of them surgically if the patients wanted to be reoperated. It is concluded that tympanoplasty, even in young children, is a rewarding option with good and stable results.

Adolescent↗
PubMed2002

Prevention of nausea and vomiting with tandospirone in adults after tympanoplasty.

UNLABELLED: We have hypothesized that the 5-hydroxytrypta-mine-1A receptor agonist tandospirone reduces postoperative nausea and vomiting (PONV). In a double-blinded, randomized design, 3 groups of 30 patients each received 1 of the following oral medications 90 min before arrival in the operating room, together with famotidine 20 mg: 1) placebo (P group), 2) tandospirone 10 mg (T10 group), or 3) tandospirone 30 mg (T30 group). Standard anesthetic regimens and techniques were applied for all patients. All episodes of PONV were recorded during the following time intervals: 0-3 h and 3-24 h after the end of general anesthesia. The incidence of a complete response, defined as no PONV and no need for other rescue antiemetics, was significantly more frequent in the T30 group than in the P group during 0-24 h (P = 0.019), especially during 3-24 h (P = 0.007) after general anesthesia. In conclusion, premedication with oral tandospirone is effective against PONV in patients undergoing tympanoplasty under general anesthesia. IMPLICATIONS: Oral tandospirone reduced the incidence of postoperative nausea and vomiting without significant adverse effects in adults undergoing tympanoplasty under general anesthesia.

Adolescent↗
PubMed1989

Cartilage palisade tympanoplasty.

Recurrent tympanic membrane perforations are usually caused by underlying conditions such as an adhesive process with a poorly aerated middle ear space, a thermal perforation, infection, or technical error at the time of graft placement. Despite surgical treatment these reperforations pose a significant otologic problem that may lead to the development of chronic otitis media and cholesteatoma. The purpose of this study is to detail the use of a new cartilage palisade tympanoplasty technique that has yielded a 100% tympanic membrane closure rate without recurrent perforations in 52 operated ears over a 2-year period. The acoustic properties of the rebuilt tympanic membrane were analyzed for types I, II, and III tympanoplasty and revealed a significant improvement in the postoperative air bone gap.

Adolescent↗
PubMed2001

Cartilage palisade tympanoplasty and diving.

OBJECTIVE: To determine whether a patient with a serious defect of the tympanic membrane (TM) will be able to dive after surgery. PATIENTS AND METHODS: The authors describe three patients who were divers with serious defects of the TM (more than 75% of TM). In all three cases, cartilage palisade tympanoplasty was used to reconstruct the TM. RESULTS: Six months after surgery, the patients passed clinical examinations, audiograms (hearing restored to normal), tympanometry (increased stiffness of the TM), and pressure tolerance tests in hyperbaric chamber (30-m immersion was simulated for 4 minutes), and they began to dive again. Approximately 2 years after the surgery, all three patients are able to dive without any difficulties. CONCLUSION: The authors conclude that patients can dive after cartilage palisade tympanoplasty.

Acoustic Impedance Tests↗
PubMed2002

Use of homograft dehydrated temporal fascia in tympanoplasty.

OBJECTIVE: To investigate the results of myringoplasty operations using homograft dehydrated fascia temporalis (Tutoplast) and compare these with those performed with autograft fascia temporalis. STUDY DESIGN: Prospective cohort. SETTING: University hospital. PATIENTS: Forty-three adult patients (> or =18 years of age) with central, dry perforations of pars tensa with intact ossicular chains. INTERVENTION: Tympanoplasty with an endaural approach and underlay technique was performed. Homograft dehydrated temporal fascia was used in 22 patients, and autograft was used in the remaining 21 patients. MAIN OUTCOME MEASURES: Preoperative and postoperative air-bone gap and speech reception threshold levels and postoperative compliance values of the homograft and autograft groups were compared. RESULTS: Postoperative perforations were encountered in two patients (9.1%) from the homograft group and three patients (14.2%) from the allograft group. Significant postoperative improvements in air-bone gap and speech reception threshold values were detected for both groups (p < 0.05). Although the mean compliance of the tympanic membranes was significantly lower in the homograft group, no statistically significant difference was observed between groups when the postoperative air-bone gap and speech reception threshold values were compared. CONCLUSION: Homograft temporal fascia can be used in tympanoplasty with the same success rate of autograft temporal fascia without impeding hearing. Its main advantages are the reduction in the duration of surgery and the length of preauricular and postauricular incisions. However, the advantages of the dehydrated homograft temporal fascia should be weighed against its cost and risk of transmission of viral and prion-mediated diseases.

Adult↗
PubMed2003

Lateralization of the tympanic membrane as a complication of canal wall down tympanoplasty: a report of four cases.

OBJECTIVE: To describe the pathophysiology and treatment of the lateralized tympanic membrane that occurs after canal wall down tympanoplasty. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral hospital. PATIENTS: Four patients in whom lateralization of the tympanic membrane developed as a complication of canal wall down tympanoplasty. RESULTS: The patients had undergone middle ear surgery 20 to 34 years before their first visit to the authors. A Bondy operation with soft-wall reconstruction of the ear canal had been performed in three patients and a modified radical mastoidectomy in one patient. They all had severe conductive hearing loss. Common findings were anterior canal sulcus blunting, good tubal function, normal middle ear mucosa, and mobile stapes. At revision surgery, the lateralized tympanic membrane was removed, and the temporalis fascia was grafted medial to the malleus manubrium. The exposed bony surface in the ear canal was covered with a split-thickness skin graft, and the ear canal and the mastoid cavity were tightly packed to secure the graft. All the patients regained good hearing after the revision. Although deterioration of the anterior tympanic ring was presumed to be the primary cause of the graft lateralization, the lack of a posterior bony ear canal might have facilitated this condition. CONCLUSION: Lateralization of the tympanic membrane can occur even in an ear with a radicalized mastoid cavity, especially when the anterior tympanic ring is torn and the posterior ear canal is reconstructed with soft tissue.

Bone Conduction↗
PubMed2003

Prolonged middle ear ventilation with the cartilage shield T-tube tympanoplasty.

BACKGROUND: In 1994, the favorable experience with composite cartilage shield tympanoplasty was reported to the American Otological Society. On that occasion, the technical question regarding the concomitant placement of a ventilating tube was posed. In response, the authors proposed that the tympanostomy tube be incorporated in the cartilage graft. Moreover, they proposed that this marriage, when used to reverse atelectasis and to repneumatize the middle ear, should offer the advantage of both procedures while reducing the incidence of tube extrusion and other complications of prolonged intubation. Although attractive in theory, this supposition could be validated only after prolonged follow-up, reported here. OBJECTIVE: To describe an effective means to secure prolonged middle ear ventilation in a patient population prone to atelectasis and chronic middle ear effusion and to establish the incidence of favorable and unfavorable outcomes after 6 years of observation. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: Forty patients (28 adults and 12 children) who underwent tympanic membrane reconstruction with a composite cartilage shield T-tube "unit."RESULTS The overall retention rate was 62.5% over 6 years. Sixty-five percent of retained tubes were maintained for a minimum of 4 years in adult patients. Extrusion and permanent perforation rates were 0%. CONCLUSION: The cartilage shield T-tube tympanoplasty can effectively reverse atelectasis and provide prolonged middle-ear ventilation. The technique can be used safely and minimizes the risk of tympanic membrane perforation and other complications associated with prolonged middle ear intubation.

Adolescent↗
PubMed2003

Middle ear mechanics of Type III tympanoplasty (stapes columella): II. Clinical studies.

OBJECTIVES: To determine the structural features that are responsible for the large variation in postoperative hearing results after Type III stapes columella tympanoplasty, to compare the clinical results after Type III tympanoplasty with predictions based on experimental investigations using a temporal bone model, and to investigate the effectiveness of a modification in surgical technique for Type III reconstruction. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. INCLUSION CRITERIA: The ear was healed with an intact tympanic membrane graft; the status of the stapes was known, whether mobile or fixed; and the postoperative status of aeration of the middle ear was known, whether aerated or not. MAIN OUTCOME MEASURE: Air-bone gap at frequencies 250, 500, 1,000, 2,000 and 4,000 Hz. RESULTS: In ears with temporalis fascia graft onto stapes head: mobile stapes and aerated middle ear (n = 34), mean air-bone gaps at audiometric frequencies were 15 to 30 dB, consistent with predictions of the experimental model; mobile stapes and nonaerated middle ear (n = 16), large air-bone gaps of 35 to 55 dB; fixed stapes and aerated middle ear (n = 4), large air-bone gaps of 30 to 50 dB; fixed stapes and nonaerated middle ear (n = 2), large air-bone gaps of 30 to 70 dB. In ears with a fascia-cartilage graft onto stapes head, where a thin disc of meatal cartilage, 0.3 to 0.5 mm thick and 4 to 6 mm in diameter was interposed between the fascia graft and the stapes head: mobile stapes and aerated middle ear (n = 9), mean air-bone gaps at audiometric frequencies were 10 to 25 dB, about 5 dB better at 250, 500, and 2,000 Hz than in ears with only a fascia graft ( <0.05), improvement consistent with that observed experimentally when a thin cartilage disc was used in the temporal bone model, hypothesis that the cartilage increased the effective vibrating area of the graft; mobile stapes and nonaerated middle ear (n = 2), air-bone gaps were 40 to 50 dB. CONCLUSIONS: Large air-bone gaps of 30 to 70 dB occurred as a result of stapes fixation, nonaeration of the middle ear, or both. When the stapes was mobile and the middle ear was aerated, a fascia graft resulted in air-bone gaps of 15 to 30 dB. Interposing a thin disc of cartilage between the fascia graft and stapes head to improve the effective vibrating graft area gave better hearing, with air-bone gaps of 10 to 25 dB. The clinical Type III results were consistent with predictions based on experimental investigations of mechanics of the Type III procedure in a temporal bone model.

Acoustic Impedance Tests↗
PubMed2004

An analysis of the single-stage tympanoplasty with over-underlay grafting in tympanosclerosis.

OBJECTIVES: Our objective was to analyze the results of tympanosclerosis surgery using over-underlay tympanoplasty and to find out the effect of single-stage surgery on hearing results. MATERIALS AND METHODS: Forty-two patients who were operated on for tympanosclerosis between July 1998 and February 2002 were included in the study. These were one-stage tympanoplasties, because second-stage operations and revisions were not included. Operative records and audiograms of the patients were obtained. Of the patients, 48% had bilateral tympanosclerosis. In three (7.1%) of the patients, tympanosclerosis and cholesteatoma occurred concomitantly. The cog was present in eight (20%) of 40 mastoidectomies. Körner's septum was present in nine (22.5%) patients. The graft take rate was 95.2%. RESULTS: The pre- and postoperative air-bone gap values of the patients were not significantly different (p > 0.05). Thirty-three percent of the patients met the successful hearing criteria (air-bone gap <20 dB). However, 47% had an air-bone gap closure between 20 dB and 30 dB, whereas 20% had a gap of more than 30 dB. CONCLUSION: Single-stage surgery does not result in a satisfactory hearing improvement in most of the patients with tympanosclerosis. Only one third of the patients, most of whom had a mobile stapes, had satisfactory hearing results. Mobilization of a fixed stapes is not an effective option for hearing restoration in tympanosclerosis. Second-stage surgery for stapedectomy and placement of a prosthesis-like piston or total ossicular replacement prosthesis should be considered to obtain better hearing results in tympanosclerosis.

Audiometry, Pure-Tone↗
PubMed2005

Acellular allograft dermal matrix for tympanoplasty.

PURPOSE OF REVIEW: Reconstruction of the tympanic membrane is a common procedure in otology today. Many different materials have been used for this purpose, including a wide array of autologous tissues. This article focuses on the use of human acellular allograft dermal matrix (AlloDerm, LifeCell Corporation, Branchburg, New Jersey) in tympanoplasty. RECENT FINDINGS: The choice of graft materials has expanded to include human dermal allograft tissue. Recent reports show promising results for AlloDerm reconstruction of the tympanic membrane, including animal experiments and in humans. SUMMARY: AlloDerm has become an acceptable alternative to the use of autologous tissues in tympanic membrane surgery, particularly in type I tympanoplasty. This paper discusses the recent literature on the topic, outlines the authors' experience with the use of AlloDerm, and describes the authors' operative technique.

Collagen↗
PubMed1977

Experiences in homograft membrane tympanoplasty.

Experience of a short series of 37 cases of tympanoplasty involving the use of a homograft tympanic membrane is presented, with a discussion of the problems involved. The initial results correspond to the earlier series' anatomical success rates and indicate that these grafts will become widely used as an effective method of tympanoplasty.

Ear Ossicles↗