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PubMed2001

[Hyperacusis after tympanoplasty].

A case of hyperacusis after tympanoplasty is presented. A 62-year-old woman experienced unilateral conductive hearing loss for about 60 years after antrotomy in infancy. Neurological or otoneurological symptoms were not evident. Tympanotomy showed a missing incus with discontinuity of the chain. Reconstruction was performed by interposition of a partial ossicular replacement prosthesis (PORP). The postoperative audiogram revealed minimal perceptive hearing loss in the high-frequency field in the operated ear. Several weeks after middle ear surgery, the patient complained of hyperacusis on the operated side, which persisted for more than 2 years. To alleviate the unpleasant sensations, an ear plug was used by the patient. In spite of the asymmetric hearing loss, no late onset auditory deprivation could be diagnosed. The pathophysiological causes of the hyperacusis have not yet been clarified. Possible reasons are discussed.

Audiometry, Pure-Tone↗
PubMed2005

Evaluation of the relation between audiometric and psychometric measures of hearing after tympanoplasty.

The objective of this prospective study was to evaluate the relation between audiometric and psychometric measures after tympanoplasty from the perspective of preoperative selection of patients and postoperative assessment of the results of reconstructive middle ear surgery. Hearing (dis)ability was measured by means of pure-tone audiometry and a validated self-assessment questionnaire: the (modified) Amsterdam Inventory of Auditory Disability and Handicap (m)AIAD. Average hearing thresholds and (m)AIAD scores were evaluated for 80 patients, pre- and 12 months postoperatively. The average improvement of the air conduction threshold in the operated ear was 5.4 (+/-14.3) dB; the average improvement in the (m)AIAD score was 2.9 points (+/-12.1). Although not very strong, the audiometric improvement and increase in (m)AIAD score are significantly related. After the calculation of postoperatively measured mean scores on the (m)AIAD for different 10-dB intervals of postoperative hearing loss averaged over both ears, an interesting relation between the (m)AIAD score and hearing losses emerges. The (m)AIAD score is almost independent of hearing loss for postoperative hearing levels between 25 and 40 dB. Residual hearing loss has to become less than 25 dB before a smaller hearing loss corresponds with a higher (better) (m)AIAD score. For losses larger than 40 dB the (m)AIAD score clearly decreases with increasing hearing loss. Finally, even small residual hearing losses lead, on average, to (m)AIAD scores that are substantially lower than the score for normally hearing subjects. In general, the patient benefit seems related to the magnitude of improvement in the air-conduction thresholds, rather than to the achievement of a certain threshold level. In addition, even small residual hearing losses (less than 25 dB HL) still lead, on average, to (m)AIAD scores that are substantially lower than the scores for normally hearing subjects.

Adolescent↗
PubMed1991

Tympanoplasty surgery at the Red Cross War Memorial Children's Hospital 1986-1988.

Results of tympanoplasty surgery over a 3 year period in 96 children aged 2-12 years were analysed to better define indications for surgery and prognostic factors. Nineteen percent had a hearing loss associated with a dry perforation--grafts were successful in 84% and 71% improved hearing to less than 20 dB. Forty-two percent had a hearing loss but also troublesome recurrent infection--grafts were successful in 88% but only 65% improved hearing to less than 20 dB. Thirteen percent had troublesome recurrent infection--grafts were successful in 79%. Twenty-two percent had uncontrolled infection, a cortical mastoidectomy together with myringoplasty produced a 75% take rate. Graft take was not affected by age, type of surgery, infection status or perforation size. Poor nutritional status and postoperative infection both had negative tendencies. In this small series there was a 10% re-perforation rate.

Age Factors↗
PubMed2004

Subjective evaluation of post-tympanoplasty hearing in relation to the pure tone threshold.

OBJECTIVE: In the year 2000, the Otological Society of Japan proposed a new criteria to assess the levels of hearing known as Criteria 2000. However, these criteria are intended to assess pure tone threshold after tympanoplasty and the results do not necessarily reflect the hearing condition from the patient's perspective. Thus, it is essential to study the relationship between the subjective evaluation of post-operative hearing based on the patient's own assessment and the objective assessment by audiometry. METHODS: The present study is a questionnaire-based survey on the levels of post-operative hearing in 460 patients whose degree of satisfaction with their levels of hearing was assessed by visual analogue scale (VAS). The hearing level was assessed based on the Criteria 2000 established by the Otological Society of Japan. RESULTS: The post-operative results indicated a success rate of 78.7%. According to the questionnaire-based survey, 64.4% patients considered their hearing as "improved". The average VAS score was the highest in the "improved" group and gradually decreased when in the "deteriorated" group. The highest success rate was obtained in patients who assessed their hearing as "improved" and the lowest rate was seen in those who assessed their hearing as "deteriorated". On the other hand, the success rate in the three groups, "slightly improved", "unchanged", and "slightly deteriorated", was almost similar and did not relate to the objective audiometry findings. Therefore, except for the "improved" and deteriorated" groups, there is no relation between the subjective self-assessment and the objective post-operative hearing. CONCLUSION: A bi-directional approach, one from an audiological (objective) and one from the patient's perspective (subjective), especially using VAS, is quite useful for the post-operative assessment of hearing.

Adolescent↗
PubMed2006

Revision tympanoplasty including anterior perforations and lateralization of grafts.

Not long ago, the restoration of a perforated tympanic membrane by grafting over an air-containing tympanic cavity seemed impossible. Fortunately, successful results are so consistent and universal today that restoration of the tympanic membrane is expected, and a failure calls for careful evaluation as to "why". If known principles are observed, few complications need occur. Usually, complications are the result of either the choice and placement of the graft used in the repair, or the presence of unresolved upper respiratory pathology. When revision tympanoplasty is necessary, use of the underplay fascial graft technique, properly applied, usually can solve any difficult problems.

Fascia↗
PubMedDate not supplied

[Results of tympanoplasty with antrum exclusion in the treatment of middle ear cholesteatoma].

INTRODUCTION: Exclusion of the antrum was designed to avoid the problem of mastoid ventilation by means of insufficient eustachian tube. MATERIAL AND METHODS: We retrospectively reviewed 72 ears with cholesteatoma who underwent antrum exclusion tympanoplasty (57% in men, mean age 40.9 years). Mean follow-up was 31.2 months (range, 12-64 mo). RESULTS: Exclusively epitympanic-antral cholesteatoma location (28.4%), and the necrosis of the long branch of the incus (54%) were the most common. The most used material to reconstruct the ossicular chain was Torp prosthesis (73.6%), followed by incus autograft (11.1%). We reported the following complications: postoperatory otorrhea (5.5%), perforation of neotympanum (16.7%), prosthesis extrusion (23.6%, time average of 15.6 months), and recurrence of cholesteatoma (4.2%). DISCUSSION/CONCLUSION: The technique with antrum exclusion has reported acceptable results in the control cholesteatoma recidivism. Although the functional results are similar to those of the open techniques, the resulting cavity with the antroexclusion is more anatomic.

Adolescent↗
PubMed1999

Results of tympanoplasty with titanium prostheses.

To improve the hearing results associated with tympanoplasty, we performed the operation in 113 cases (124 ears) using ossicular replacement prostheses made of titanium. The results demonstrated that among all the operated ears, 115 of 124 (92.7%) had a hearing gain of more than 10 dB. The average improvement of pure-tone hearing was 24.6 dB, and the average reduction of the air-bone gap was 23.2 dB. No rejection reaction or recurrent cholesteatoma was found. This operative technique, based on animal experiments and applied anatomic study of the suprastapedial structure in human beings, has had a good rate of success and has resulted in remarkable hearing improvement of a relatively large magnitude. The application of a new material-titanium-which has high biocompatibility with human body tissues, is in large measure the reason for this success. The ossicular replacement prosthesis was appropriately designed and manufactured. It fit well, could be tightly joined to the suprastapedial structure, and was difficult to displace. We also adopted the method of enlarging the tympanic isthmus, which led to good aeration of the mastoid and attic, resulting in the best state of mobility of the tympanic membrane. All these factors contributed to the effective hearing gain.

Adolescent↗
PubMed1987

Computed tomographic evaluation of middle ear aeration following intact canal wall tympanoplasty.

The condition of the mastoidectomy cavity following intact canal wall tympanoplasty (ICWT) is always of great interest to the otosurgeon. We evaluated the status of postoperative aeration in a stable ear following ICWT for various types of chronic otitis media using high-resolution computed tomography (CT). The mastoidectomy cavity in all the cases of simple suppurative otitis is totally aerated and that in over 60% of the cases of adhesive otitis, attic type cholesteatoma and adhesive type cholesteatoma is obliterated by a soft tissue density mass. The size of aerated spaces in the postoperative middle ear cavity not only depends on the type of chronic otitis media but also tends to correlate with the degree of mastoid pneumatization in the opposite ear. CT is useful for the postoperative assessment of middle ear aeration.

Adolescent↗
PubMed1975

Tympanoplasty on only hearing ears.

The methods, results, and indications for operation on only hearing ears are discussed on the basis of 13 patients operated upon for chronic otitis media and its sequelae. Although good results were obtained, with an air-bone gas closure within 15 dB. in 77 per cent, this should not serve as propaganda for the general use of surgery on only hearing ears. On the other hand, they show that surgery on only hearing ears should not be rejected a priori and that on certain indications and under c ertain circumstanc es it may be carried out with minimal risk of aggravating the hearing loss. In most of the patients the indication for surgery was a progressing cholesteatoma, in some cases the sequelae of otitis, either in the form of myringoplasty or type II tympanoplasty, and one patient had the operation on a vital indication. To avoid postoperative exacerbation of the hearing, the patients must be strictly selected, the ears have to be pretreated conservatively, the Eustachian tube must be passable, the operation must be carried out by the most experienced otosurgeon, and thoroughly tested, very gentle operative methods must be used.

Adult↗
PubMed1983

Late results of tympanoplasty using ossicle or cortical bone.

Hearing results are presented for 164 ears with chronic otitis media which were operated on radically and obliterated with a musculo-periosteal flap (Palva flap), and in which tympanoplasty was performed. The ears were followed-up annually for 5-13 years (mean 6.8 years). Results are compared with the method of ossiculoplasty and with the condition of the stapes superstructure at operation. Ossiculoplasty using autogenous cortical bone columellas resulted in a somewhat greater improvement in the post-operative air-bone gap than ossiculoplasty with auto- or homo-graft ossicles, when compared with the pre-operative gap. Similarly, the post-operative gap improved more in ears with an intact stapes superstructure than in ears in which the stapes superstructure was absent. The use of an autogenous cortical bone columella can be recommended in cases in which the patient's own ossicles are affected by disease and cannot be used.

Adolescent↗
PubMed1986

Silastic coated incus in tympanoplasty: a preliminary report.

In 54 ears lacking the stapedial arch and the long process of the incus, ossiculoplasty was performed with a shaped auto- or homologous incus as columella. In 29 of the ears, the deep, slender part of the columella was coated with a silastic tube in order to prevent adhesions and dislocation. One year after the operation the functional results were similar in patients with silastic coating of the incus to those without. It is concluded that the less satisfactory results of tympanoplasty in such ears are primarily caused by factors outside the niche of the oval window. Possible ways of improving the results are discussed.

Adolescent↗
PubMed1993

The prognostic value of mucociliary clearance in predicting success in tympanoplasty.

Mucociliary and equipressive eustachian tube functions have been studied, using saccharin solution (five per cent sodium saccharinate) and tubal manometry respectively, in 58 ears with chronic disease undergoing tympanoplasty. The position of the perforation site determines the results as the poorest results are obtained from the posterior ones, positive cases (47 per cent) and mean transport time (37.7 minutes), compared to the greater percentage of positive cases (86 per cent) and mean transport time (22.2 minutes) for anterior perforations. When both parameters are analysed together there is a direct relationship between normal equipressive function and normal mucociliary transport time and between negative transport time and tubal blocking. Significant difference in transport times have been found for the anterior and posterior perforations being shorter for the anterior ones. When surgical outcome is correlated with mucociliary transport, the normal transport time percentage is seen to be considerably higher in the success group (50 per cent) than in the failure group (22 per cent).

Adolescent↗
PubMed1995

The need for excessive dietary sodium chloride following tympanoplasty.

Loss of a single nerve function in the peripheral network responsible for taste perception is traditionally considered clinically insignificant. However, we report the case of a 27-year-old woman who experienced significant selective taste loss for salt after manipulation of the chorda tympani during tympanoplasty. This effect may be explained by disorder of the functional neuroanatomy of salty taste perception together with strong lateralization of mastication to the affected side in this patient. Recently described inhibition of cranial nerve IX by cranial nerve VII is hypothesized as contributing to the contradiction between this case and the commonly accepted role of the chorda tympani in taste perception.

Adult↗
PubMed1995

Causes of failure of combined approach tympanoplasty in the treatment of acquired cholesteatomas of the middle ear and the mastoid.

Forty cases of failed combined approach tympanoplasty were analysed. The commonest cause of failure was adhesions between the facial ridge and the tympanic membrane, causing segmental attico-mastoid malaeration in 51.3 per cent of cases followed-up continually. Other causes were, large dermoids, incomplete removal of squamous epithelium, and eustachian tube obstruction. Eustachian tube dysfunction did not appear to be a major cause of failure.

Cholesteatoma, Middle Ear↗
PubMed2003

A study of recurrence of retraction pockets after various methods of primary reconstruction of attic and mesotympanic defects in combined approach tympanoplasty.

The major drawback of combined approach tympanoplasty (CAT) is a relatively high rate of cholesteatoma recurrence compared to open-cavity techniques, which is thought to occur primarily by recurrence of retraction pockets. In this series of 63 CATs carried out by one surgeon, scutum reconstruction to prevent recurrent attic retraction was carried out in 43 cases. Repair with bone pate proved much more successful in achieving this (20.7%; 6/29 recurrent retraction pockets) compared to tragal cartilage (57.1%; 8/14) (Fisher's exact test, P = 0.0205) and was found to be a result of the greater incidence of cartilage resorption. Recurrence of retraction in pars tensa defects was more common as the only material used was a simple temporalis fascia graft. The mean time to development of recurrences was 21.1 months and that has important implications for follow-up. We conclude that the use of bone pate for scutum reconstructions reduces the incidence of attic retraction pockets, and therefore the risk of cholesteatoma recurrence following CAT.

Adolescent↗
PubMedDate not supplied

Laser-assisted tympanoplasty for preservation of the ossicular chain in cholesteatoma.

We report the use of potassium titanyl phosphate laser-assisted tympanoplasty in amputations of the malleus and incus in 2 patients with cholesteatoma medial to those ossicles that had not destroyed the ossicular chain continuity. In both cases, the laser successfully removed portions of the ossicles to allow removal of the cholesteatoma; importantly, the laser preserved certain ossicular ligaments, thus keeping the ossicular chain continuous. Postoperatively, both patients showed satisfactory hearing. Although the prevalence of cholesteatoma medial to the ossicles with maintained ossicular continuity is limited, the laser-assisted procedure described here is useful for maintaining hearing ability in these cases.

Adult↗
PubMed2003

[Tympanoplasty with adipose tissue].

BACKGROUND: Among other materials it is also possible to use autologous fat tissue for closing tympanic membrane perforations. In this study we have evaluated 44 consecutive myringoplasties with adipose tissue performed between 1999 and 2001. MATERIAL AND METHOD: The indications were residual microperforations following tympanoplasty with temporalis fascia or tympanic membrane perforations due to trauma or chronic otitis media simplex. Myringoplasty with fat tissue was performed as an outpatient procedure and took about 15 minutes. The adipose tissue was harvested from the posterior side of the ear lobe in local anaesthesia. After refreshing the borders of the tympanic membrane perforation with a micro hook, the adipose tissue was positioned into the perforation by using a handheld or fixed ear speculum. The graft was covered with a silk strip soaked with Garamycine ointment. In bigger perforations a bed of gelfoam was put into the tympanic cavity in order to avoid adhesions between the graft and the promontorium. RESULTS: A permanent healing of the tympanic membrane was achieved in 40 (91 %) out of the 44 patients. In 21 patients hearing improved between 5 -10 dB. Surgical complications did not occur. CONCLUSIONS: Our results indicate that transcanal myringoplasty with adipose tissue is a simple and minimally invasive method for closing small to medium sized tympanic membrane perforations.

Adipose Tissue↗