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PubMed1978

Modified technique of tympanoplasty with functional results of 494 cases after 3 years.

This paper gives the functional preliminary and final results of tympanoplasty as modified by Khan in types I--III in the form of a comparison. We examined 494 patients who were operated according to our modified technique. It is emphasized that in reconstruction of the middle ear, the use of a prepared fascial graft, homograft incus cartilage and external auditory meatal flap is sufficient. The preliminary and final results were documented with the aid of audiograms which were described and critically appraised according to two different types of evaluation. The evaluation did not only include the hearing results of tympanoplasty, but also the change in individual frequencies for all types. According to our appraisal of the operations with regard to social hearing the functional results of operations performed in our clinic may be considered above average. The hearing gain achieved from the preliminary postoperative control to the final examination is especially satisfying, since it also includes an improvement in bone conduction values.

Auditory Threshold↗
PubMed1978

Tympanoplasty: the fundamentals of the concept.

The development of tympanoplasty based on a fundamental understanding of the mechanisms of the middle ear in health and disease is described as it evolved. As a consequence of problems arising from the creation of an open cavity further developments led to the concept of a 'closed' operation which in turn has its own disadvantages. These are principally concerned with aeration of the tubotympanic cleft. The most recent phase of tympanoplasty is concerned with limiting the extent of the procedure to what is required to expose the disease process and re-establish function.

Anti-Bacterial Agents↗
PubMed1983

Tympanoplasty with mastoidectomy: present status.

There are many problem areas in tympanoplasty surgery. For the most part the extent of the problems relates directly to how vigorously one pursues a good functional result: the harder the surgeon tries, the more problems he may have. There are also many controversial areas in tympanoplasty, most of which relate to technique. In regard to tympanic membrane grafting and management of the sound pressure transfer mechanism, how well the surgeon performs the operation is far more important than which of the variety of techniques he uses. In relation to obtaining an air-containing mucous membrane-lined middle ear space and the management of the mastoid, there are many philosophical and emotional factors. There are many ways to manage the mastoid in cholesteatoma surgery, all of which can be successful if properly performed. We use all procedures but prefer the intact canal wall technique. The major advantage of the intact canal wall procedure is that the surgeon may avoid a post-operative mastoid cavity. The main disadvantages of this technique are the problems of recurrent and residual cholesteatoma, problems that necessitate a two-stage procedure in the majority of patients.

Cholesteatoma↗
PubMed1996

Surgical results of tympanoplasty with hokudai-shaped partial and total ossicular replacement prostheses.

The surgical results of tympanoplasty using a ceramic partial ossicular replacement prosthesis (PORP) or a ceramic total ossicular replacement prosthesis (TORP) were analyzed. The present study included 25 ears in 22 patients who underwent tympanoplasty between December 1986 and September 1994 and were followed up for more than 6 months postoperatively. Because the ceramic prosthesis was extruded from 2 of the 25 ears, the surgical results in the other 23 ears were analyzed, Surgical results were assessed according to a criterion that permits comparison with data from around the world. The criterion considers a postoperative airbone gap within 20 dB as a success. According to this criterion, the success rate was 90.9% for PORP, 50.0% for TORP, and 69.6% in total. These results are comparable with those found at other centers.

Adolescent↗
PubMed1976

Personal experience with tympanoplasty in children.

An analysis is presented of a series of 434 operations in chronic otitis media in children taking into account the extent of the lesion, the type of operation, the early and late functional and morphological results. In 18% of cases a radical operation was performed, in 21% atticotomy or other conservative operations, and in 61% open or closed tympanoplasty. Because of dynamic character of the cholesteatomatous process in childhood, the creation of a "safe ear", i.e. free of recurrences of cholesteatoma, is difficult by means of closed tympanoplasty operations.

Child↗
PubMed1980

Cholesteatoma. Etiology, nosology and tympanoplasty.

After more than 25 years of tympanoplasty for cholesteatomata, it is time to reconsider the origin of this pathological finding. The pathogenesis has not changed, it is the aspects of the disease which have shifted. There are two reasons for this: (a) much improved conditions of living, housing, nutrition and epidemiology, especially during childhood, and (b) discontinuation of the indication for radical surgery, only in the case of threatening complications is tympanoplasty used as a prophylactic operation. In the meantime a new and numerously large group of cholesteatomata has come up which was previously unknown, namely the so-called 'iatrogenic cholesteatomata'. Under these aspects the nomenclature of the cholesteatomata has to be newly defined, according to its etiology and form of disease.

Cholesteatoma↗
PubMed2000

Results of tympanoplasty in children after 15 to 27 years.

Results of tympanoplasty in children with noncholesteatomatous chronic otitis media are presented in a 16- to 27-year follow-up. During the 13-year period from 1968 to 1980, 116 children (124 ears) were operated on, and they were submitted to several follow-ups with audiometry and otomicroscopy. The attendance at the last follow-up was 70%, and the minimum time since surgery for these patients was 15 years. All dry ears were operated on transcanally with a fixed ear speculum, without any lateral incision of the ear canal skin. Cumulatively, in total, 14 ears (11%) had reperforation: 7 ears early and 7 ears late. At 6 months, there were 6% early reperforations; some were surgically closed and some reappeared later, even after several years, as late perforations. At 2 to 15 years of follow-up, there were 4% reperforations, and at 16 to 27 years, 6%. Hearing was good and stable. The results were the same in ears operated on at the ages of 2.5 to 7 years and 8 to 14 years, as well as with preoperatively positive and negative Valsalva maneuvers. In total, 14% of ears were revised during the entire observation period. It is concluded that transcanal tympanoplasty, even in young children, has good long-term stability and can definitively and permanently solve the problem of noncholesteatomatous chronic otitis in children.

Adolescent↗
PubMed2006

Tympanoplasty for chronic otitis media in post-irradiated nasopharyngeal carcinoma patients.

OBJECTIVES: We evaluated the surgical outcome of tympanoplasty for chronic otitis media in post-irradiated patients with nasopharyngeal carcinoma. METHODS: Nineteen ears were treated in 15 patients with nasopharyngeal carcinoma who had undergone radiotherapy in this retrospective clinical series. Only patients with simple perforations of the tympanic membrane and normal or near-normal eustachian tube function were enrolled in this study. All patients underwent type I tympanoplasty. RESULTS: All patients had been treated with radiotherapy of 64.8 to 81.0 Gy. The intervals between radiotherapy and surgery ranged from 17 months to 20 years. The tympanic membranes in 10 of 19 ears were intact after surgery. Otorrhea had subsided in 11 ears (58%), and the incidence of otorrhea was decreased in 6 ears (32%). Thirteen of the 15 patients (86.7%) reported that their quality of life had improved. CONCLUSIONS: Surgical intervention benefits some patients with nasopharyngeal carcinoma with chronic otitis media resulting from radiotherapy.

Adult↗
PubMedDate not supplied

The fate of cartilage grafts for ossicular reconstruction in tympanoplasty.

Summary--Six autograft tragal cartilages and two preserved homograft nasal septal cartilages removed from revision tympanoplasty were examined with histologic and histochemical stains. The implanted cartilage remained in the middle ear from six months to eighteen months without significant inflammatory reaction or evidence of resorption. It appears that the implanted cartilages removed from tympanoplasty have been well tolerated in the middle ear space.

Adolescent↗
PubMedDate not supplied

Prevention of recurrent cholesteatoma in closed tympanoplasty.

Recurrent cholesteatoma in a series of 534 staged intact canal wall tympanoplasties performed over a 10-year period has been reviewed for the present study. Overall detected incidence of recurrent cholesteatoma is 5.2% (28 of 534 operated ears). A steady decrease of recurrent cholesteatoma was found, however, in the second period of our surgical experience (1978 to 1982) when prevention techniques were adopted in all operations, resulting in a 1.07% incidence (four of 373 operated ears). Our present policy for prevention of recurrent cholesteatoma in intact canal wall tympanoplasties with mastoidectomy includes the use of plastic sheeting with thick Silastic, the repair of bony sulcus defects with cartilage shavings, staging of the operation with preplanned reexploration of the middle ear and mastoid, and transtympanic ventilation tube insertion in cases of refractory tubal insufficiency.

Adult↗
PubMed1996

Allograft tympanoplasty type 1 in the childhood population.

Seventy allograft type 1 tympanoplasties in children under 16 years of age were studied retrospectively. Only patients with a tympanic membrane perforation without cholesteatoma and a normal ossicular chain were included. Short-term and long-term anatomic and functional results were analyzed after a mean follow-up of 40 months. The overall short-term take rate was 97% and the long-term take rate was 88%. A number of variables with alleged prognostic value for surgical outcome were analyzed, but none showed statistical correlation with either anatomic or functional results. A median hearing gain of 10 dB was achieved, which was stable over time. We conclude that allograft tympanoplasty type 1 in this group of children is anatomically and functionally successful regardless of age.

Adolescent↗
PubMed1997

Mechanics of type IV tympanoplasty: experimental findings and surgical implications.

In a type IV tympanoplasty, the stapes footplate is directly exposed to incoming sound while the round window is "shielded," usually with a fascia graft. Postoperative hearing results are quite variable, with air-bone gaps ranging from 10 to 60 dB. A cadaveric human temporal bone preparation was developed to investigate the middle ear mechanics of this operation to identify causes of variable results and to test predictions of a recently described theoretic model of type IV tympanoplasty. The ear canal, tympanic membrane, malleus, and incus were removed so as to expose the stapes and round window to the sound stimulus. A "cavum minor" chamber (air space adjacent to the round window) was constructed around the round window niche. The round window could be isolated from sound by placing an acoustic shield over this chamber. The mechanical properties of the shield, cavum minor, annular ligament, and round window membrane were varied experimentally. Stapes velocity as determined by an optical motion sensor was used as a measure of hearing level. The largest stapes velocity occurred with a mobile stapes and round window, a stiff shield, and a well-aerated cavum minor. Partial fixation of the stapes or round window caused a decrease in stapes velocity. Acoustic shields of conchal cartilage or Silastic silicone rubber sheeting (approximately 1 mm thick) provided near-optimal shielding. A temporalis fascia shield resulted in a stapes velocity 10 to 20 dB less than that seen with a cartilage or Silastic silicone rubber shield at low frequencies. A cavum minor air space as small as 16 microL was sufficient for unrestricted stapes motion, provided the air was in contact with the round window membrane. These results qualitatively matched predictions of our model, but there were some quantitative differences. The clinical implications of our results are that in order to optimize postoperative hearing, the surgeon should 1) preserve normal stapes mobility, preferably by covering the footplate with a very thin split-thickness skin graft, not a fascia graft; 2) reinforce a fascia shield with cartilage or Silastic silicone rubber; 3) create conditions that promote aeration of the round window niche; and 4) preserve the mobility of the round window membrane.

Adult↗
PubMed1991

Tympanoplasty: to stage or not to stage.

No unanimity of opinion exists in regard to staged operations in tympanoplasty. The controversy centers around the degree to which one should attempt to obtain hearing improvement in badly diseased ears. The major factor is the extent of the mucous membrane disease. We review the history of staging, the mucous membrane indications for staging, and the variations involved in canal-wall-down (CWD) procedures. The opinions of nineteen other otologists also are presented, nine of whom do not regularly or ever stage tympanoplasty.

Humans↗
PubMed1993

Laser welding of fascial grafts and its potential application in tympanoplasty: an animal model.

This study evaluates the welding effect of argon laser on fascial grafts and its potential application in tympanoplasty. An animal model was designed so that surgically induced perforations of the lumbar fascia of the animals were grafted in an underlay fashion. Each graft was "spot welded" around the circumference of the perforation using a hand-held argon laser. Various lasing parameters were used on different grafts. Control perforations were grafted but not welded. A total of 96 perforations was studied. Weld sites were evaluated both histologically and by tensile strength measurement at the end of surgery, and at 7, 14, and 21 days postoperatively. Comparison with controls showed a higher tensile strength for welded grafts, which was most significant in the early postoperative period (p < 0.001). Histologically, it seems that the basic mechanism of fascial welding involves liquification and denaturation of extravasated proteins at the weld sites. Correlation between the extent of thermal damage on the tissues and the various lasing parameters is described. Based on the well-documented safety of argon laser in otologic surgery, and the successful welding of fascial grafts in this study, argon laser may prove beneficial in welding temporalis fascia grafts in tympanoplasty.

Animals↗
PubMed2003

Canal wall down tympanoplasty with canal reconstruction for middle-ear cholesteatoma: post-operative hearing, cholesteatoma recurrence, and status of re-aeration of reconstructed middle-ear cavity.

The post-operative outcome of hearing, the reconstructed external auditory canal, and the state of the reconstructed middle-ear cavity after canal wall down tympanoplasty with canal and attico-antrum reconstruction was studied in 103 ears with middle-ear cholesteatoma. The reconstructed mastoid cavity was re-aerated in 36.5 per cent of the cases, which was significantly lower than for the epitympanum (63.5 per cent) and tympanic cavity (82.4 per cent). Tympanoplasty was successful in terms of hearing results in 68.9 per cent of all subjects and in 75.4 per cent of the ears having a re-aerated tympanic cavity, which was significantly better than the 38.5 per cent for ears in which the tympanic cavity was not re-aerated. The findings of recurrent cholesteatoma, tympanic atelectasis, and tympanic effusion were observed with significantly (p<0.03) high incidence in ears with no re-aerated space in their reconstructed mastoid cavities. It was revealed that the post-operative outcome of this surgical technique was significantly related to the state of re-aeration of the reconstructed middle-ear cavity.

Adolescent↗
PubMed1983

The anterior tympanomeatal angle in tympanoplasty: surgical techniques for the prevention of blunting.

The surgical repair of the anterior tympanic membrane with reconstruction of the vibrating anterior tympanomeatal angle is particularly difficult because of problems with graft separation, recurrent perforations, scar formation and blunting. The multilayer tympanoplasty technique anchors the structural layer of the drum to the annulus, by fixing the underlay fascial graft to the overlay graft, and reduces scar formation and blunting by immediate epithelial coverage of the vibrating anterior tympanomeatal angle. The purpose of this paper is to describe the multilayer sandwich graft tympanoplasty technique that has been effective in reconstructing the anterior tympanic membrane with preservation of the vibrating anterior tympanomeatal angle.

Cicatrix↗