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At least 217 records · Page 12Linked to original sources
PubMed1984

Type I tympanoplasty: influencing factors.

Type I tympanoplasties utilizing an underlay technique with temporalis fascia performed at the Medical University associated hospitals over a 5-year period were reviewed. Cases were excluded if follow-up was less than 18 months or if a previous tympanoplasty had been performed. The remaining 71 cases, 40 adults and 25 children, were analyzed for influencing factors. The overall success rate was 89%. The age of the patient, the length of time the ear had been dry, and the presence of infection at the time of surgery had no influence on the success rate. The two factors which adversely influenced the success rate were the presence of a near total or total perforation and the presence of bilateral perforations.

Adolescent↗
PubMed1985

Hearing results in tympanoplasty.

Recent reports from Scandinavian authors have put forth the concept that hearing improvement following tympanoplasty is seldom satisfactory and difficult to obtain. This view is contradictory to the experience of most American authors. A study, therefore, was undertaken to evaluate the hearing results obtained by this author through the use of homograft material in middle ear and mastoid reconstruction. These hearing results are categorized according to time periods, types of reconstruction, and materials used. The hearing statistics are all taken from audiograms obtained one year or more postoperatively. These correspond with the type of reconstruction employed such as an intact ossicular chain, absence of the malleus, absence of the superstructure of the stapes, or both. Other categories include tympanoplasty with mastoidectomy or reconstruction of the posterior canal wall with homograft knee cartilage. The surgical techniques are not discussed in this article because they have been detailed in previous publications.

Audiometry↗
PubMed1987

Prognostic value of eustachian tube function in pediatric tympanoplasty.

Poor eustachian tube function and prevalence of infectious ear disease are thought to be the reasons for less successful outcome associated with tympanoplasty in children. Since both of these factors are related to age, identification of those patients who may benefit by delaying the surgery has been a concern to otolaryngologists. In an effort to investigate the role of eustachian tube function on the outcome, we tested the tubal function in 63 ears (56 children) undergoing tympanoplasty for central perforations. In 49 ears (78%), the graft took; of these, 33 had good middle-ear function, 8 developed persistent or recurrent otitis media, and 8 had severe retraction or atelectasis. There was a significant association (p less than 0.01) between outcome and preoperative tubal function as determined by combining the active and passive function parameters. However, the prognostic value of tubal function testing was low; predictive values for success and lack of success being 68% and 56%, respectively. Other factors, such as graft placement (medial or lateral) contralateral ear status, and child's age, were not associated with outcome. Consistent with other studies, good eustachian tube function was shown to predict good outcome, but poor tubal function was not helpful in predicting poor outcome.

Adolescent↗
PubMed1989

Results of tympanoplasty for congenital aural atresia and stenosis, with special reference to fascia and homograft as the graft material of the tympanic membrane.

The surgical management of congenital aural atresia is a challenging, complex procedure, and the risks are great. The otologic surgeon is responsible for keeping a patent external auditory canal and for achieving satisfactory hearing. The present report studied hearing changes that occurred after tympanoplasty and the long-term results of tympanoplasty in 12 cases of congenital aural atresia or stenosis. Patients were followed for more than 2 years after surgery. In four ears, an allograft of the tympanic membrane with an attached malleus was used, with a good graft take and hearing results. An autograft of temporal fascia was used in eight ears. Hearing acuity decreased in six of the eight ears and was maintained in two ears. Three primary surgery patients required revision surgery for postoperative restenosis of the external auditory canal. Some comments have been made with regard to this problem. Emphasis is also placed on the selection of patients for surgery using a thorough audiologic and roentgenologic evaluation.

Adolescent↗
PubMed1993

Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology.

In ears with advanced pathology, the functional and anatomical results of surgery are compromised by such factors as total perforation, tympanosclerosis, atelectasis, suppuration, or previous surgery. Perichondrium cartilage composite grafts (PCCGs) were used for membrane grafting in 550 such cases over a period of 5 years. In all, 197 tympanoplastic procedures of type I (25% with previous surgery) and 353 of type III (47% with previous surgery) were carried out. The graft was obtained from the tragus and/or the concha. Two slightly different surgical techniques of grafting were used. Closure of the eardrum perforation was successful in 92% of the procedures. An air-bone gap of less than or equal to 30 dB was obtained in 92.4% of tympanoplasty type I procedures and in 79% of tympanoplasty type III procedures. The conclusion drawn from the results is that PCCG is a reliable graft in cases of advanced destruction of the middle ear.

Cartilage↗
PubMed2002

Type III tympanoplasties: the Sherbrooke experience.

OBJECTIVES: To review short- and longer-term results of type III tympanoplasties as performed by the senior author and to compare these results with those reported in the literature. METHOD: Retrospective review of 96 type III tympanoplasties, with and without mastoidectomy, performed between April 1996 and August 2000. RESULTS: At a mean of 384 days postoperatively, 57.3% of patients had an air-bone gap of less than 20 dB. The average postoperative gap is 21.4 dB. Gap closure is best at 2000 Hz, with an average drop of 51% from initial value, compared with 34%, 39%, and 18% at 500, 1000, and 4000 Hz, respectively. CONCLUSION: Our results are similar to those published previously. We emphasize the improvement at 2000 Hz, which is an important frequency for speech discrimination. It would be interesting to see if it correlates with an improvement in quality of life.

Adolescent↗
PubMed1996

Lysates from cultured allogeneic keratinocytes stimulate wound healing after tympanoplasty.

In the past, cultured keratinocyte allografts have been used with benefit in the treatment of burn wounds and leg ulcers. Since in burn wounds autologous and allogeneic fresh keratinocyte cultures were found to give similar favorable results as lysates of allogeneic cultured cells, the authors investigated whether this lysate mixed in an antibiotic suspension would also accelerate the epithelial healing after routine tympanoplasty. In a double blind setting the healing process in 50 consecutive tympanoplasty ears was studied: an acceleration of healing of 8 days was observed in the lysate-treated group (39.25 days) as compared with the control group (47.23 days). The percentage of ears which healed within 6 weeks (after 5 weekly applications of 200 microliters suspension in both groups) was significantly higher in the treated group (61%) than in the control population (36%). Although the therapeutical effect of the keratinocyte lysate in this study is believed to be due primarily to its mitogenic activity through growth factors or cytokines, at present it is still unclear which growth factors are involved and which combinations of these factors have to be present to modulate the different stages of the complex healing processes.

Administration, Topical↗
PubMed2001

[Fatal pulmonary embolism developing after tympanoplasty: a case report and incidence of pulmonary embolism at Toyooka Hospital].

We report a case of fatal pulmonary embolism (PE) developing after tympanoplasty. A 69-year-old woman underwent type III tympanoplasty for a middle ear cholesteatoma under general anesthesia. Operating time was 3 hours 27 minutes and anesthesia lasted 5 hours 9 minutes. The next morning, 14 hours 5 minutes after returning to the recovery room, the patient lost consciousness while getting out of bed. Although consciousness recovered transiently, she went into shock with cardiopulmonary arrest. Heart beat was regained after resuscitation with artificial respiration and cardiac massage, but her blood pressure was unstable. Echocardiography revealed right ventricular overload and pulmonary hypertension. Because PE was suspected, thrombolytic therapy was conducted to stabilize hemodynamics. Enhanced computed tomography (CT) of the chest showed bilateral pulmonary thromboembolism. The patient died of hypoxic encephalopathy 23 days after PE onset. We have seen 40 cases of PE at our hospital in the last 70 months. Five patients developed PE after surgery with a postoperative occurrence rate of 0.03% (5/16, 277), and 3 of them died. Enhanced CT in 19 of 21 cases (90.5%) before or just after the start of therapy for PE was useful in establishing the diagnosis. Although PE is rare in the field of otolaryngology and head and neck surgery, it may develop rapidly after any type of surgery resulting in a fatal outcome. It is thus important to establish diagnosis early and prevent such serious complications.

Aged↗
PubMed1991

[Tympanoplasty with mastoid obliteration using hydroxyapatite granules for aural cholesteatoma--a clinical and experimental study].

Hydroxyapatite granules were employed for mastoid obliteration in cases of aural cholesteatoma. After eradicating a cholesteatoma by the canal-down technique, the canal wall was reconstructed with cortical bone chips, and the mastoid cavity was obliterated with hydroxyapatite granules. Tympanoplasty by this technique was performed on 48 ears with aural cholesteatoma. There was no recurrence of cholesteatoma during the follow-up period of two years after surgery. One case of residual cholesteatoma was found in the mesotympanum. There were two cases in which the hydroxyapatite granules became exposed through the posterior canal skin. An air-bone gap of less than 20 dB was achieved in 73% of all the patients. Experimental studies in guinea pigs have demonstrated that hydroxyapatite granules do not undergo morphological changes in and are tightly interdigitated with newly formed bone tissue growing from bulla bone one year after hydroxyapatite implantation in the temporal bullae. The newly-formed bone showed incomplete osteon structures. Excellent biocompatibility and bone adaptability of hydroxyapatite granules were demonstrated experimentally. It is concluded that tympanoplasty with mastoid obliteration using hydroxyapatite is safe and useful for avoiding mastoid cavity problems and for preventing the recurrence of cholesteatoma.

Adolescent↗
PubMed1994

[Tympanoplasty in cholesteatoma otitis media with normal hearing].

Thirteen cholesteatomas, with hearing within 20dB, were operated on from 1985 to 1992. Their mean age was 22.1 years, and the mean follow-up period 1.8 years. Eleven cases were pars flaccid type, and 2 cases pars tensa type. Tympanoplasties were performed by the canal down method (4 cases), the canal up method (3 cases), both transmeatal atticotomy and scutumplasty (4 cases) and both the canal down method and mastoid obliteration (2 cases). Postoperative hearing results of three averaged speech frequencies were within 20dB in 11 cases and between 20 and 30dB in 2 cases. No recurrent cholesteatoma or extrusion of columella occurred during the follow-up period. One of the cases operated on by the canal down method showed postoperative mastoid cavity problems, and one of the cases operated on by the canal up method showed retraction of the pars flaccida. These findings prompted us to operate on cholesteatoma cases with normal hearing and to recommend tympanoplasty with transmeatal atticotomy and scutumplasty.

Adolescent↗
PubMed1998

[A modification to traditional combined approach tympanoplasty].

A modified method of traditional combined approach tympanoplasty (CAT) was performed on for 86 cases (89 ears). The patients were followed-up on for 18-50 months. No recurrent cholesteatoma or cochlear hearing impairments were found, and all the tympanic membranes had healed. The results of pure tone hearing tests showed that 66 ears (74%) had partial hearing (higher than 30 dB HL level), 56 ears (63%) had a small gap between BC and AC (< 10 dB HL), 10 ears (11%) had no hearing improvement. The total effective rate (the pure tone hearing improved more than 10 dB HL after operation) was 89% (79 ears). The clinical application of this kind of modified operation method had shown its important significance in thoroughly removing the diseased tissue, in preventing recurrent or residual cholesteatoma, in substantial hearing reconstruction and in improving the function of tympanum. Also the indication of combined approach tympanoplasty has been extended.

Adolescent↗
PubMed2001

[A closed variant of staged tympanoplasty with mastoidectomy in patients with chronic purulent otitis media].

127 case records were analysed retrospectively. All the patients had otitis media purulenta chronica and had undergone tympanoplasty (a closed variant). Regular revision of the trepanation cavity was performed in patients with cholesteatoma. Residual cholesteatoma was detected in 5 of 76 patients with cholesteatoma before the first operation, recurrent cholesteatoma occurred in 2 patients. Normal position of the neotympanic membrane and recovery of normal anatomy of the external acoustic meatus were achieved in 116 (91.3%) operated patients. Preservation or improvement of hearing were observed in all the patients. Bone-air gap under 30 dB was obtained in 79%. Thus, the proposed variant of closed staged tympanoplasty is effective for sanation of the infection focus with subsequent hearing improvement.

Adult↗
PubMed2002

[Tympanoplasty with the use of autologous tissue].

There are presented results of 87 tympanoplasties performed in the Department of Otolaryngology Medical Academy in Białystok from 1997 to 1998. In 35 (40.02%) of treated ears there were cholesteatoma, granulation or (and) polyps. Tympanosclerosis, diffuse synechiae and mucosal discharge (non-reacting to pharmacotherapy) were also encountered during surgery. 65 (74.8%) of patients were operated on by closed methods including reconstruction of tympanic membrane, ossicular chain, posterior and superior wall of external canal using autologous tissue such as temporalis fascia, adipose tissue, cartilage, perichondrium or bone. In operations using open methods, post-operative cavities were reduced using musculo-fascial transplants or bone to decrease the space of the antrum and mastoid process. Tympanic membrane and ossicular chain were repaired at the same time. Drainage of post-operative cavities was performed in some cases which lasted 3-8 weeks. Anatomical and functional results of surgery were good in 62 (71.2%) of cases. The pathologic condition in the middle ear had a significant influence on the post-operative results. Unsuccessful results of tympanoplasty were due to recurrences of cholesteatoma, adhesion, diffuse tympanosclerosis, infection and secretory middle ear mucosa.

Ear Diseases↗
PubMed2002

Selection of surgical interference in mastoidectomy with tympanoplasty.

OBJECTIVE: To discuss the long-term results of different surgical patterns for chronic suppurative otitis media. METHODS: The data of 231 cases of chronic suppurative otitis media who underwent open-mastoidectomy with tympanoplasty (OMT), combined approach tympanoplasty (CAT), and intact bridge mastotymplasty (IBM) and were followed up for 2 - 5 years from 1990 to 2001 were collected to analyze the surgical technology, long-term recurrence rate, and level of hearing improvement. RESULTS: The improved hearing threshold level of air conduction in 0.5, 1, 2 KHz was 21 dBHL after IBM, significantly higher than that after OMT (12 dBHL) and that after CAT (9.5 dBHL). The long-term recurrence rate was 24.4% after CAT, higher than that after IBM (8.3%) and that after OMT (5.8%). CONCLUSION: IBM is a good choice for preserving or improving hearing based on eradication of the focus among patients with chronic suppurative otitis media.

Adolescent↗
PubMed2001

[Two terms tympanoplasty in chronic suppurative otitis media].

OBJECTIVE: To explore the clinical manifestations and therapeutic effects of treating chronic suppurative otitis media with two terms tympanoplasty. METHOD: 36 patients were retrospectively analyzed. The criterions of success are air room in middle ear, intact eardrum and decrease of A-B gape in audiometry. RESULT: 32 cases of all patients got successful effects, 4 cases failed. The main cause of failure is to fail forming air room in middle ear. CONCLUSION: The two term's tympanoplasty can save the residual hearing in most patient. But it is difficult to get successful result if more mucous membrane in the middle ear disappeared.

Adolescent↗
PubMed2003

[The art of tympanoplasty and its clinical illustration].

INTRODUCTION: The development of tympanic membrane surgery is based on 150 years of surgical experiences, medical and technological innovations. There are two major techniques of tympanic membrane reconstruction depending on the graft related to the different anatomic layers of the eardrum. AIM OF THE STUDY: We evaluate different risk factors of the tympanoplasty such as the age of the patient, the tubal function, the middle ear inflammation, the status of the contra-lateral ear, the localization and the size of the perforation, the surgical techniques and the type of the graft. METHODS: We illustrate and comment on those risk factors considering 122 simple tympanoplasties and a large overview of the literature. RESULTS: We show that the graft position doesn't interfere with the surgical results and we specify our attitude to control the risk factors. CONCLUSION: To obtain excellent results, surgical indications have to be extremely rigorous as with surgical techniques.

Adult↗
PubMed2003

Aural aspergilloma: an unusual delayed complication of tympanoplasty.

Aural aspergilloma was first reported in 2001 by the authors. Recently the authors discovered a second case presenting with chronic otorrhea via a fistulous tract in the tympanic membrane. The patient was treated by removal of the fistulous tract and part of the tympanic membrane, cleansing the middle cavity, leaving the tympanic membrane perforated until obtaining a dry ear and followed by a tympanomastoidectomy, without the use of an antifungal agent. Because both cases of aural aspergilloma had a history of successful tympanoplasty with a long quiescent period before the symptoms appeared, the authors postulate that aural aspergilloma may be considered as an unusual delayed complication of tympanoplasty.

Adult↗