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PubMed1983

[Tympanoplasty in children].

Tympanoplasty in childhood is not always the same as in adults. This applies to the indication for the operation, to the operation itself and also to the pre- and postoperative treatment. The rapidly growing and expanding juvenile cholesteatoma offers special problems, and probably has a different cause than the slow growing pearl tumour found in adults. Traumatic cholesteatomas also give the impression of growing faster in childhood. The prognosis for tympanoplasty in cases of mesotympanic chronic otitis media must not be too optimistic because the condition of the mucosa in juveniles is different to that in adults. Pre-operative treatment may take a long time and postoperative treatment may be difficult.

Child↗
PubMed1978

Tympanoplasty grafting and ossicular reconstruction.

Tympanoplasty is a surgical procedure that has been used in various modifications for the last 25 years for chronic ear disease. The goals of tympanoplasty are to control the infection and at the same time to restore the ear to a more normal state with the hope of improving hearing.

Chronic Disease↗
PubMed1980

Tympanoplasty--25 years later.

The surgical details of tympanoplasty, the importance of the pathology, the proper selection and preparation of the patient have been emphasized. The results of the procedure have been discussed. While at times disappointing, the operation tympanoplasty as viewed over 25 years has been established in the armamentarium of the otologic surgeon.

Adult↗
PubMed1982

[Use of a body acoustic probe and the conduction of brain stem potentials for the determination of sound conduction during tympanoplasty].

A new procedure of evoking brain stem potentials is introduced. Contrary to evoking brain stem potentials by acoustic stimulation via earphone or loudspeaker, we touch the middle ear apparatus at various locations using a piezoelectric transducer with a screwed-on probe, thus causing physiological movements within the sound conducting structures (Fig. 3). As a reaction to this kind of stimulation--1000 clicks with a duration of 0.1 ms were given--far field brain stem potentials can be recorded. The calibration of this special sound probe--not bigger than a pencil (Fig. 1)--was made by equalizing the mechanically and acoustically evoked guinea-pig brain stem potentials (Fig. 2). The intraoperative control of sound transmission to the inner ear is ascertained by the mechanically evoked potential's latency and amplitude. In order to apply the procedure in tympanoplasty we made a number of recordings after having simulated various kinds of middle ear pathology in the guinea pig. Four cases of various kinds of ear disease (interruption of the ossicular chain - Fig. 4 -, soft tissue bridge between incus and stapes - Fig. 5 -, otosclerosis - Fig. 6 -, Torp prosthesis - Fig. 7 -) are presented. As a result of our intraoperative recordings we can demonstrate that the presented method may be a valuable contribution to the examination of acoustic transmission through the middle ear during tympanoplasty under general anesthesia.

Animals↗
PubMed1981

[Tympanoplasty and Tinnitus (author's transl)].

One third out of 181 patients who had been operated for chronic otitis, had tinnitus. In one third of these patients with tinnitus the ear noise disappeared after the tympanoplasty, in one third it remained unchanges and in one third the tinnitus appeared after the tympanoplasty.

Cholesteatoma↗
PubMed1981

[The treatment of chronic adhesive otitis by tympanoplasty and active self-insufflation according to valsalva (author's transl)].

More than one year after tympanoplasty 85 to 95% of the followed up middle ears are aerated. The percentage depends on the degree of the preoperative adhesive process. We see the reason of this surprising success on the one hand in some special steps during operation (consequent silastic sheeting, preservation of the posterior bony canal with a deep middle ear cleft, visualisation of the tympanic orifice of the tube, widening of the natural connection between tympanon and mastoid without opening the chorda-facial-angle, some times mastoidectomy), on the other hand in a consequent postoperative follow up together with the surgeon until the ear is surely aerated controlled by self-insufflation (Valsalva). Therefore a preoperative tubal dysfunction is no contraindication for tympanoplasty: all ears should be operated. Because of the good results in hearing after just one operation, we try to rebuild the ossicular chain during the first intervention to avoid as often as possible a staged surgery.

Audiometry↗
PubMed1981

[Tympanoplasty in septic cases. A new technic].

The very incidence of postoperative sepsis in tympanoplasty operations on ears with infected cholesteatoma prompted the development of a new technique to improve the control of local infection. An irrigation tube is placed into the mastoid antrum at the time of operation, through which the ear is irrigated in the postoperative period with an antibiotic solution. In 25 tympanomastoidectomy operations, only 6 patients developed postoperative sepsis, 5 of which were due to faulty administration of the antibiotic. In 13 tympanoplasty operations, 6 patients had an unsuccessful outcome. Four of these were due to poor patient selection. Systemic antibiotics are given immediately preoperatively, and continued in the postoperative period until the course has been completed.

Anti-Bacterial Agents↗
PubMed1981

Aeration of the middle ear and mastoid in tympanoplasty.

In order to achieve a good hearing result following tympanoplasty it is necessary to maintain an aerated middle ear space. Poor Eustachian tube function is most commonly blamed in cases of failure to obtain an adequately aerated middle ear following tympanoplasty. Although this may be the true etiology in some cases, middle ear adhesions, loss of support of the posterior canal wall and inadvertent blockage of the Eustachian tube orifice by graft material may be contributing factors. Aeration of the mastoidectomy cavity is also important to prevent collapse of the posterior canal wall, retraction pockets and to insure an adequate air reserve. Surgical techniques for prevention of these complications and a means of bypassing the totally blocked Eustachian tube are discussed.

Adult↗
PubMed1980

Tympanoplasty in children.

To evaluate the possibility that current teaching regarding the postponement of tympanoplasty as desirable in young patients might be less correct than previously thought, the results in 260 ears in patients aged less than 16 years were scrutinized. It was found that not only were the functional results comparable to those obtained with adult patients, but also that there was little evidence of subsequent deterioration of initially good hearing results with time. The findings in regard to postoperative cholesteatomatous complications were in agreement with those previously reported and were not different from those in adult patients. It is concluded that, with children, in the interests of health, educational progress and social integration, tympanoplasty procedures, often in two stages, should be carried out as soon as concomitant upper respiratory disease is brought under control. Childhood cholesteatoma is not a "different" disease. Functional results are the same as with adults and are influenced by identical deficiencies in our technical ability.

Adolescent↗
PubMed1980

[Regenerative capacity of the tympanic mucosa following tympanoplasty (author's transl)].

From adult temporal bones with clinically normal ears mucous lining specimens were taken and investigated microscopically. Comparing these specimens with biopsies from the tympanon of patients following tympanoplasty, we could detect an over-all correspondence of epithelial and subepithelial cell structures of normal tympanic mucosa and of ears operated upon because of chronic inflammation. These findings suggest that the middle ear epithelium is an only partial developed mucociliar - and not an pluripotential - epithelium, arising by ingrowth of respiratory mucosa of the nasopharynx. It reacts upon every exogenic or endogenic irritation always in direction to complete differentiation. This differentiation is caused by stimulation of the O2-metabolism following such various proceedings as traumatisation, inflammation, otospongiosis activity, experimental tympanoplasty or explanation into tissue culture. The generally reversible process should not be defined as metaplasia.

Ear, Middle↗
PubMed1995

Preventive tympanoplasty in children: a new approach.

Chronic middle ear effusion with serous or mucus accumulation but without other associated tympanic and middle ear pathology can be successfully treated in many cases with myringotomy and ventilating tubes. But there are cases on which there are atrophic tympanic membrane areas with retraction into the middle ear, tympanic membrane adhesions to the long process of incus and incudo-stapedial joint with or without retraction toward the facial and tympanic recesses and shallow attic retraction pockets, which eventually will lead to cholesteatoma formation. All these minor anatomical distortions are usually asymptomatic, but with a potential to generate cholesteatomas throughout the years and cannot be corrected with a simple myringotomy and ventilation tube insertion. In these particular cases we have developed some types of tympanoplasty procedure that may prevent further progression to cholesteatoma formation. The purpose of this presentation is to describe these preventive tympanoplasty techniques and analyze the short and long term results in 68 surgical procedures.

Adolescent↗
PubMed1994

Tympanoplasty in children--our experience in Riyadh, Saudi Arabia.

A seven years results of 75 cases of tympanoplasty without mastoidectomies in children is presented and analyzed. The study showed a perforation closure rate of 81.33%, hearing improvement to within 25 dB was 61.33%. The hearing did not improve in 18.66%. There is no higher incidence of recurrent perforation in children as compared to adults. In developing country such as Saudi Arabia experiences, skill, and proper development of facilities for management and post-operative care in distant areas may prove helpful in improving the results of tympanoplasty.

Adolescent↗
PubMed1994

[Tympanoplasty using chondro-perichondral graft. Indications, techniques and results. Apropos of a series of 127 cases].

In an attempt to avoid recurrence, the authors have used chondro-perichondral grafts for more than 10 years for tympanoplasty of retraction pouches. Early results were published in 1987. This new retrospective series of 127 tympanoplasties, performed from 1987 to 1991 reports the anatomic and functional results obtained and the technical modalities used. After a mean follow-up of 18 months, the results appear encouraging. Indications of this chondro-perichondral graft have been widened to cases of unsuccessful first intention myringoplasty and to certain cases of progressive perforations occurring in a setting of inflammation or tubal dysfunction. The results must be confirmed on the basis of long term outcomes.

Adolescent↗
PubMedDate not supplied

[Bioceramic prosthesis of the ear ossicles in tympanoplasty].

Anvil bones bioceramic prostheses were used in tympanoplasty performed in 60 patients with chronic otitis media purulenta (COMP). Complete and partial variants of the prostheses were tried. Follow-up results available for 60 patients demonstrate that the above tympanoplasty improved hearing in 41 out of 60 patients, made possible complete cavity epidermization, arrested inflammation, secured safety of the tympanic transplant in 51 patients. Bioceramic prostheses of the anvil bones provide stable hearing improvement even in COMP cases with severe impairment of the anvil bones.

Acute Disease↗
PubMed1993

Prevention of recurrence of cholesteatoma in intact canal wall tympanoplasty.

In the treatment of cholesteatoma employing intact canal wall tympanoplasty, staging the operation and re-establishment of aeration of the tympanic cavity are required to eradicate possible causes of recurrence, cholesteatoma residue, and retraction pocket. The planned staged tympanoplasty with preventive measures for recurrence has evolved. At the second-stage operation, one of the following three types of operations was performed according to the grade of aeration and healing of tympanic cavity: type S1, only ossiculoplasty; type S2, ossiculoplasty and scutumplasty; and type S3, ossiculoplasty, scutumplasty, and mastoid obliteration. The surgical concept, indication, and technique are described in detail. The recurrence rate in the 134 patients without previous surgery, 95 adults and 39 children, operated on between 1987 and 1991 was 2.2 percent (7.6% in the children and 0% in the adult). Although the rate of the recidivism was significantly reduced, deep retraction pocket developed in 15 percent of adults and in 23 percent of children. The incidence of deep retraction pocket formation was lowest in the adults with type S1 operation and highest in the children with type S3 operation.

Adolescent↗
PubMed1977

Joseph Toynbee Memorial Lecture, 1976. Tympanoplasty--four heterodox techniques.

Polarization between proponents of intact canal wall tympanoplasty and radical (modified) mastoidectomy in the treatment of cholesteatoma and other irreversible temporal bone lesions can be avoided in many cases by the use of one or more special techniques. These include (a) Gelfilm (no-graft) induction of tympanic membrane regrowth; (b) the use of tragal cartilage and perichondrium in columellization and in Type III neomyringostapediopexy; (c) the use of laboratory-prefabricated ossicular homografts to correct malleal-capitulum and malleal-footplate discontinuities more precisely; and (d) the circumferential approach (circumnavigation of patient's head) and anterior position of the surgeon in order to visualize the sinus tympani, retropyramidal, and retrofacial areas, obviating extensive posterior tympanotomy bone dissections. These techniques make possible a third alternative to the choice of either combined-approach tympanoplasty or radical or modified radical mastoidectomy in the treatment of a number of advanced temporal bone lesions.

Cartilage↗
PubMed1977

[A comparison of the results of incus interposition in the Wullstein type III and type IV tympanoplasty (author's transl)].

Incus interposition for reconstruction of the sound conduction mechanism in a deep tympanic cavity can be effectively utilized in both Wullstein Type III and IV tympanoplasties. In the Type III tympanoplasty, in which the incus is interposed between malleus or tympanic membrane and stapes, the average post-operative air-bone gap approximates 16 db, while incus placement on the stapes footplate results in an air-bone gap of 23.5 db. There is no difference in change of bone conduction when all operative mehtods are compared. Improved results in reconstruction of the second conduction mechanism are best obtained by conserving or reconstructing the tympanic membrane and posterior bony external canal wall through improved audio-physiologic dynamics.

Ear Canal↗
PubMed1995

[Acoustic characteristics of external auditory meatus after tympanoplasty with open mastoid reconstruction].

This study investigated the effects of down-wall tympanoplasty (open technique included skeletonizing of mastoid) upon external auditory meatus resonance characteristics. The probe tube microphone measurement was performed twice pre and post operatively. The resonance frequency of external auditory meatus remained constant, but the peak amplitude was increased by 0.83dB SPL (P < 0.05). The results indicated that a tympanoplasty with standard open techniques did not affect the normal external auditory meatus resonance characteristics.

Acoustics↗