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PubMedDate not supplied

[Anatomo-topographical bases of post-tympanoplasty recurrence of cholesteatoma].

25 specimens of the temporal bone were studied to ascertain specific anatomical features of the pockets and sinuses of the tympanic cavity provoking cholesteatoma recurrence after tympanoplasty. An original method is provided of systemic revision of the tympanic cavity along the perimeter to detect and remove cholesteatoma parts hidden in the tympanic cavity pockets and sinuses. After application of the above method the occurrence of the recurrences went down to 9.7%. Intraoperative findings show that cholesteatoma may invade each pocket and sinus of the tympanic cavity both in primary epi-, epimesotympanitis and in cholesteatoma recurrence following open and closed tympanoplasty. In both groups sinus of the facial nerve, posterior tympanic sinus and tympanic cavity suffer most frequently.

Cholesteatoma, Middle Ear↗
PubMed1997

[Annular wedge tympanoplasty: a variation of overlay myringoplasty].

Myringoplasty has been increasingly refined in recent years and today the most frequently employed are the "overlay", the "underlay" and the "interlay". Of these the overlay technique appears to best guarantee graft stability. However, with this technique there is the risk of blunting and neotympanum lateralization which can compromise functional recovery. To obviate these drawbacks, the authors propose a modification of the classical overlay technique. This modification consists of detachment of the anterior portion of the Gerlach annulus and the adjacent protympanum mucosa in order to insert the graft between the bony and fibrous portions of the annulus. This technique is defined as the "Annular Wedge Tympanoplasty" (AWT). From January 1993 to July 1994 a total of 74 tympanoplasties were performed using the AWT technique to reconstruct the tympanic membrane. In 71 (96%) of these, the opening closed completely. As regards incomplete healing, 2 cases showed signs of blunting, 3 showed posterior lateralization and 1 full lateralization with a reduction in the hearing level recovery. The work is not conclusive although it does present a technique which is easy to perform and which provides good functional recovery.

Adolescent↗
PubMed1998

Underlay tympanoplasty with anterior and posterior flaps for subtotal perforations.

In conventional underlay tympanoplasty, post meatal flap is elevated and graft placed medial to the handle of maleus. Out of this present series of 200 ears, in 90 cases posterior flap technique and in 110 cases both posterior and anterior flap was applied and results are studied after median observation time of 20 months. The success rate with combined anterior/posterior flap is better compared to the posterior flap alone. Different techniques described by various authors for tympanoplasty are also discussed in this paper.

Humans↗
PubMed1997

Tympanoplasty in young patients: the role of adenoidectomy.

A retrospective study of 60 pediatric patients with dry tympanic membrane perforation undergoing type I tympanoplasty during a 15-year period was carried out. Seventy-seven percent of patients were followed up for 5 years. The overall success rate was 90%. All failures occurred in patients who previously had undergone adenoidectomy or adenotonsillectomy. However, sex was found to be the only statistically significant prognostic factor of tympanoplasty success: female patients had higher success rates than male patients. Neither patient age, prior ventilation tube placement, size of perforation, status of the contralateral ear, surgical technique (underlay or overlay), nor competence of the surgeon (resident or senior) affected the success rate. The possible reasons for these findings will be discussed.

Adenoidectomy↗
PubMed2006

Posterior canal wall reconstruction with a composite cartilage titanium mesh graft in canal wall down tympanoplasty and revision surgery for radical cavities.

OBJECTIVES: To investigate posterior external ear canal wall reconstruction with a composite cartilage titanium mesh graft in canal wall down tympanoplasty and revision surgery for open mastoids. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral centre. METHODS: As a preliminary study, 15 selected patients underwent reconstruction of a posterior ear canal wall defect with titanium mesh. Large defects of the posterior external auditory canal wall, resulting from canal wall down tympanoplasty or present in revision surgery, were eliminated by reconstruction using a titanium mesh. The mesh was covered with conchal cartilage and attached to the cortical mastoid bone using 3-mm titanium screws. RESULTS: All patients maintained a normal contour of the external ear canal, without depression, extrusion or infection. There were no failures, based on short-term post-operative controls. However, two procedures had to be revised due to incomplete coverage of the titanium mesh. CONCLUSIONS: This study shows that reconstruction of the posterior ear canal wall with a composite cartilage titanium mesh is a valuable method for preserving the morphology of the external auditory canal in selected cases. Problems occurring in canal wall down tympanomastoidectomy and radical cavities may therefore be avoided. However, long-term results have yet to be evaluated.

Adult↗
PubMed2001

Formaldehyde fasciaform tympanoplasty: a reliable technique for closing large tympanic membrane perforations.

Formaldehyde fasciaform grafting tympanoplasty is a reliable method, in experienced hands, to close large tympanic membrane perforations. The technique involves using autogenous temporalis fascia shaped by formaldehyde cross-linking on a special fasciaform mold (Hear America, Palo Alto, CA). This study was undertaken with the objective of assessing if an otologist with less experience in using this technique could obtain comparable results. The results of the initial 23 patients treated in this manner by one surgeon between August 1996 and January 1998 are reviewed. Success was measured by the rate of closure of the tympanic membrane perforation and by functional closure of the air-bone gap. Favourable results were obtained, with complete closure of 86% of the perforations and closure of the air-bone gap to 20 dB or less in 90% of subjects when the ossicular chain was intact. The formaldehyde fasciaform tympanoplasty technique produces consistent, reliable, and reproducible results for large tympanic membrane perforations.

Fascia↗
PubMed1979

Argon laser in human tympanoplasty.

We describe the use of an argon laser in human tympanoplasty. The laser was used in two different ways: (1) to stop the bleeding of small vessels in the external auditory channel and eardrum remains; and (2) to spot-weld the new eardrum graft in the proper position. Seven operations were performed. We report the results.

Animals↗
PubMed1980

Acute mastoiditis after a combined approach tympanoplasty operation.

Four of 112 ears on which a combined approach tympanoplasty (CAT) operation was performed had acute mastoiditis six to 24 months after operation. All four patients were younger than 13 years. This represents 12.5% of acute mastoiditis cases after CAT operations in this age group, or 3.5% of the total group. On reoperation, all four ears expressed pus under pressure in the mastoid cavity. There was also fibrosis and granulation tissue blocking the attic inlet. It is probable that the cause of the acute mastoiditis may be related to this partial or total stenosis. Two of the patients were found to have an aerated, noninflamed tympanic cavity, and only in two was the acute mastoiditis associated with residual cholesteatoma.

Acute Disease↗
PubMed1982

Late changes in hearing results after mastoid obliteration with tympanoplasty.

Hearing results are presented for 627 ears with chronic otitis media that were operated on radically and obliterated (Palva flap) and in which a tympanoplasty was performed. The ears were examined annually for five to 14 years (mean, 8.8 years). The long-term improvement (five to 14 years after the surgery) was the greatest in ears with an intact ossicular chain and in ears with ossicular reconstruction using autograft or homograft ossicles or autogenous cortical bone columellae. As a whole, the early (one year after the operation) improvement in the air-bone gap was 8.0 dB when compared with the preoperative gap and the late deterioration in gap after the first year was 6.0 dB. To detect the late changes in hearing results, the ears operated on must be followed up for a least five to ten years.

Adolescent↗
PubMed1982

Modification of combined-approach tympanoplasty in attic cholesteatoma.

Late results of operations on 224 attic cholesteatomas were analyzed three to 16 years after operation. In 133 ears a modification of combined-approach tympanoplasty was applied and in 91 ears a conservative radical operation with obliteration was performed. All ears were operated on in one stage and 11% were reoperated on during the observation period. No significant differences between the two methods were found, neither with regard to recurrent cholesteatoma--found in 6% with canal-up technique and in 2% with canal-down technique--nor regarding hearing results. With canal-up technique, retractions developed in 38% of ears that progressed and often ended up being small, peaceful, open cavities. It is concluded that treatment of cholesteatoma should be individualized, that no single method is preferable in all cases, and that an intact ossicular chain should be preserved.

Cholesteatoma↗
PubMed1994

Prevention of sinus tympani retraction following tympanoplasty. How I do it.

Tympanoplasty for sinus tympani retraction may result in delayed recurrence of the original problem. This is especially true in children with marginal eustachian tube function. Autogenous tragal cartilage, scored on one surface with perichondrium attached on the other, produces a "natural bend" in the cartilage. When placed in the middle ear, with the scored convex surface facing the promontory, retraction into the sinus tympani can be prevented. This simple, yet effective, surgical technique is outlined.

Adult↗
PubMed1977

Ventilating tubes in tympanoplasty.

The successful surgical treatment of chronic otitis media or its sequela is frequently related to a ventilated tympanic cavity. Tubes at tympanoplasty have been recommended to assure ventilation until eustachian tube and middle ear mucosal functions have been restored and to prevent the complications of graft loss, atelectasis, cholesteatoma and ossicular destruction. This presentation reviews the literature on the subject and documents our results in 40 patients treated by tympanomastoid surgery with ventilating tubes. The types of tubes used, the surgical technique involved, and the selection of cases suitable for this method are described. Cholesteatoma was the primary disease in 32 patients, 6 had chronic otitis media, 1 cholesterol granuloma, and 1 eosinophilic granuloma. Complete healing of grafts following extrusion or removal of the tubes occurred in 34 patients, 2 tubes remain in place, 3 patients had persistent tube site perforations, and 1 was lost to follow-up. None of the patients had graft breakdown as a result of tube placement, and there has been no recurrence of cholesteatoma. In all cases, the follow-up period is a minimum of 18 months and extends to 92 months.

Adolescent↗
PubMed1983

The fate of an ossicular allograft in tympanoplasty.

Correction of ossicular defects in tympanoplasty most commonly involves the use of commercially available prostheses or preserved allograft ossicles. Incus autografts and tragal cartilage autografts are also used by many surgeons. Presculptured preserved allograft ossicles have not been used widely, but are used almost exclusively by our clinic. The fate of ossicular grafts has been reported by a number of in investigators with evidence obtained at revision surgery. In this paper we will be able to trace the fate of a presculptured preserved autograft ossicle clinically and pathologically. The unique aspect of this study is the demonstration of the ossicular status in post mortem temporal bone dissection followed by histopathological serial section studies.

Aged↗
PubMed1992

Long-term hearing results of one-stage tympanoplasty for chronic otitis media.

A study of 277 ears with chronic otitis media undergoing one-stage tympanoplasty has been carried out. The mean follow-up period was 6.4 years. Ears with intact ossicular chains were excluded. Ossiculoplasty was performed using autologous ossicles or cortical bone. Mean hearing gain was 10.8 dB. Closure of the postoperative air-bone gap to within 20 dB was achieved in 51% of cases. The best results were obtained in ears with intact stapes, while cholesteatomatous ears showed poorer results than other chronic ears. The present findings show that autologous ossicle and cortical bone are still suitable for ossicular reconstruction in chronic ears, especially when one-stage surgery is preferred.

Auditory Threshold↗
PubMed1979

Homograft sclera in tympanoplasty.

Homograft sclera was used as a supporting scaffold of the tympanic membrane and reinforcement for the fascia in 43 tympanoplasties. Fresh sclera donated for corneal transplantation to the eye bank in the ophthalmology department of the School of Medicine of Keio University was preserved in 70% alcohol after being stripped of uveal tissue. The sclera was cut as an interdigited method in grafting technique and the short process and the upper part of the manubrium of the malleus were exposed. The fascia was placed lateral to the sclera to cover the exposed mallus. Twenty-four cases have been observed for more than 6 months and ten cases for 3--6 months after surgery. Although the results of the long-term follow-up cannot be judged until after many years, there have been so far no recognizable complications, and it seems quite possible that this technique can reduce the complications as lateral healing and anterior blunting of the fascia alone. The postoperative closure rate of the tympanic membrane was 90% in all the cases except Type IV (two cases). The indications for the use of sclera were discussed.

Humans↗
PubMed1977

[Experience with the inlaytechnic of tympanoplasties type I. (author's transl)].

After more than ten years of experience with the inlaytechnic of tympanoplasties type I at the ENT-department of the University of Freiburg, and evaluating tha datas of 451 consecutive ears operated between 1970 and 1974, this technic proved to be good. The quote of recidive-surgery was about 19.9%. Hearing improved markedly in 80.4% of the patients. Complications like the appearence of Cholesteatoma, lateral migration of the transplant or flatening of the anterior tympanomeatal angle have not been noticed.

Evaluation Studies as Topic↗
PubMed1981

[Gas diffusion in the middle ear during anesthesia for tympanoplasty].

The problems of diffusion of gas into the middle ear during anaesthesia have been described by several authors since 1965. The administration of anaesthetic concentrations of nitrous oxide raises middle ear pressure in the order of 3.43 to 3.92 kPa (350 to 400 mm H2O). This phenomenon disappears spontaneously after cessation of nitrous oxide anaesthesia and causes no trouble except a few cases of deafness and some rare tympanic ruptures. We have tried to solve this problem during anaesthesia for tympanoplasty by substituting air for nitrous oxide and by the use of ethrane as basic anaesthetic agent. Anaesthesia was potentiated by narcotics and the patients were adequately curarized. The results showed that this technique greatly reduced diffusion of gases if we kept the PaO2 under 17.9 kPa (135 mm Hg) and the PaCO2 at 3.9 kPa (30 mm Hg). Controls have shown that diffusion is greater with higher PaCO2. Middle ear pressure, measured with Madsen impedence-meter, was not higher than 0.68 kPa (70 mmn H2O).

Anesthesia↗
PubMed2006

[Variable length titanium prostheses for type III tympanoplasty. Intraoperative length adjustment and fixation of the cartilage overlay].

INTRODUCTION: For type III tympanoplasty by partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), the length of the prosthesis must match the individual intraoperative anatomical and physiological characteristics. MATERIALS AND METHODS: Databanks were used to determine the necessary sizer length of the sizer disc. The measurement template for the size of the cartilage to overlay the prosthesis headplate was derived from the headplates of the Tübinger titanium prostheses (TTP) and the Dresdener titanium prostheses. Finally all functions were integrated into a synthetic plate. RESULTS: The result was a simple and reasonably priced disposable multifunctional instrument (Tübinger sizer disc TSD) which allowed an exact measurement for every prosthesis in TORP and PORP. For the TTP-Variac, the TSD enabled the simple intraoperative production of prostheses with the length desired by the surgeon. For PORP the TSD enabled an adaptation of the diameter of the prosthesis foot for TTP, TTP-Vario and TTP-Variac and provided a template for the size determination of the cartilage overlay of the titanium prosthesis head. The sizers and the resulting prostheses were used for initial tympanoplastic operations. Audiometric investigations carried out 6 weeks postoperatively gave results corresponding to those previously obtained in a study with TTP and TTP-Vario using the old instrumentation. CONCLUSIONS: The new instrumentation leads to an improvement of the intraoperative practicability and a simplification. The audiological results remain the same.

Disposable Equipment↗